Outcome of critically ill lung transplant candidates on invasive respiratory support

Abstract

High-urgency LTx improves survival in critically ill intubated candidates. Higher SAPS scores, escalating therapy and an abnormal procalcitonin level were associated with a poor outcome.

Lung transplantation for chronic obstructive pulmonary disease

“…88,[90][91][92][93]96,97,190,191 Unfortunately, a more contemporary analysis of United Network for Organ Sharing (UNOS) data cannot easily be done. By incorporating an equal weighting of urgency with posttransplantation survival in order to minimize waiting list deaths, 99 the LAS distributes scarce donated organs to those most acutely in need.…”

“…87 Patients with COPD that have respiratory failure requiring mechanical ventilation or extracorporeal life support are a distinct group that have no reasonable expectation of sustained survival without lung transplantation. 88 Expert opinion suggests that invasive ventilatory support is a relative contraindication for lung transplantation. 23,24 However, a number of authors have reported cases and series of patients with measurable prolongation of life following transplantation in the setting of ongoing mechanical ventilation or extracorporeal life support for patients with COPD 65,[89][90][91][92] and other diseases.…”

“…23,24 However, a number of authors have reported cases and series of patients with measurable prolongation of life following transplantation in the setting of ongoing mechanical ventilation or extracorporeal life support for patients with COPD 65,[89][90][91][92] and other diseases. 88,89,[93][94][95][96] In all cases, patients had varying lengths of survival following transplantation with the median times measured in months or years; one group specifically examined the outcome of mechanical ventilation for endstage lung disease and found an enormous, statistically significant advantage of lung transplantation compared to conventional nonsurgical care ( Figure 1). 88 Discussion has focused on whether these patients are appropriate recipients for organs because of the possibility of reduced posttransplant survival and therefore reduced graft survival compared to patients transplanted from extremely ill states without mechanical ventilation or extracorporeal support.…”

“…88,89,[93][94][95][96] In all cases, patients had varying lengths of survival following transplantation with the median times measured in months or years; one group specifically examined the outcome of mechanical ventilation for endstage lung disease and found an enormous, statistically significant advantage of lung transplantation compared to conventional nonsurgical care ( Figure 1). 88 Discussion has focused on whether these patients are appropriate recipients for organs because of the possibility of reduced posttransplant survival and therefore reduced graft survival compared to patients transplanted from extremely ill states without mechanical ventilation or extracorporeal support. 97 Individual patients on invasive ventilation or extracorporeal support indisputably have a positive transplantation outcome compared to nontransplantation; however, posttransplantation survival is likely reduced in these patients when compared to that of transplant recipients that were spontaneously breathing prior to transplantation, regardless of pulmonary diagnosis.…”

A Step Up for Extracorporeal Membrane Oxygenation: Active Rehabilitation

“…9 Overall, outcomes following lung transplantation in patients bridged with extracorporeal life support, including ECMO, have been variable, depending on the patients, their indication for transplantation, and the configuration and duration of extracorporeal support. [10][11][12][13][14] The main benefits of awake ECMO are that the patient can eat, drink, communicate, and participate in active rehabilitation, which may be an important predictor of outcome, as reported in this issue by Rehder et al 15 In theory, early use of awake ECMO may result in more physically and physiologically stable patients, as compared to those receiving invasive mechanical ventilation at the time of lung transplantation, which may translate into improved post-transplant outcomes. Indeed, some investigators have cautioned that the use of awake ECMO may lower the risk profile of recipients, resulting in a lower priority on the waiting list.…”