Clinical lung and heart/lung transplantation
Medium-term results of extracorporeal membrane oxygenation for severe acute lung injury after lung transplantation

https://doi.org/10.1016/j.healun.2003.08.021Get rights and content

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) has been used successfully for early, severe reperfusion injury after lung transplantation. The purposes of this study are to: (1) document the medium-term survival of patients treated with ECMO; and (2) assess the extent of recovery of their pulmonary function.

Methods

We retrospectively reviewed charts of 172 patients having lung transplants at our institution from 1997 through 2002. The group included 16 patients (9% of total; 10 bilateral, 5 single, 1 living lobar) treated with ECMO for primary allograft failure after single or bilateral single-lung transplantation. Survival and bronchiolitis obliterans syndrome (BOS)-free survival rates were calculated. Pulmonary function was assessed at 2 months, 1 year and 2 years post-transplant.

Results

Median hospital stay was 48 days for the ECMO group and 16 days for the overall group (p < 0.05). The 90-day survival was 60% in the ECMO group, and 90% in the overall group. The 2-year survival was 46% in the ECMO group, and 69% in the overall group. Mean forced expiratory volume in 1 second (FEV1) in the ECMO group at 1 year was 59 ± 13% of predicted, and at 2 years 60 ± 15% of predicted; it was not significantly different for the overall group.

Conclusions

Patients treated with ECMO for primary allograft failure after lung transplantation showed acceptable medium-term survival and pulmonary function.

Section snippets

Patients

The institutional review board at the University of Minnesota approved the study protocol and all patients consented to a review of their medical records. All patients who underwent lung transplantation from January 1997 to December 2002 were eligible for the study. Transplant evaluations and hospital charts were reviewed. Data collected included pre-operative patient demographic characteristics, pulmonary function tests, echocardiograms and cardiac catheterizations as well as hemodynamic,

Results

During the 5-year study period, we performed 171 lung transplant procedures using cadaveric organs; 98 patients received single lungs (57%) and 73 received bilateral single lungs (43%). Indications for transplantation were chronic obstructive pulmonary disease (COPD) or α 1-anti-trypsin deficiency in 106 patients (64%), idiopathic pulmonary fibrosis (IPF) in 17 (10%), primary pulmonary hypertension (PPH) in 10 (6%), cystic fibrosis (CF) in 18 (11%) and miscellaneous indications in 15 (9%). The

Discussion

Primary allograft failure is the major cause of early mortality and morbidity after lung transplantation, and severe ischemia—reperfusion injury is the most common etiologic factor associated with the syndrome. In addition to their peri-operative problems, patients that survive PGF may have reduced pulmonary function and may be at an increased risk for acute and chronic rejection.3 Depending on the criteria used for diagnosis, the reported incidence of PGF ranges from 20% to 57%.4, 5, 6 Risk

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