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Early institution of extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation improves outcome

Lookup NU author(s): Chris Wigfield

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Abstract

Background: Primary-graft dysfunction (PGD) after lung transplantation (LTx) carries a significant mortality and clinical management is controversial. Extracorporeal membrane oxygenation (ECMO) has been used infrequently for recovery from acute lung injury (ALI) in this setting. We reviewed our experience with ECMO after primary LTx. Methods: The present study is a retrospective analysis of all LTx patients between 199 1 and 2004. Twenty-two patients sustained severe PGD with subsequent placement on ECMO. We analyzed indications and 30-day, 1-year and 3-year mortality. Complications and incidence of multiple-organ failure (MOF) were determined. Critical appraisal of the evidence available to date was performed. Results: A total of 297 LTxs were performed during the study period, with 97.5%, 88.6% and 73.8% survival at 30 days, 1 year and 3 years, respectively. Twenty-two patients (7.9%) had severe allograft dysfunction leading to ECMO support. Twelve patients received single-lung (SLTx), 8 double-lung (BLTx), 1 single-lung/kidney (SLKTx) and 1 heart/lung (HLTx) transplantation. Thirty-day, 1 -year and 3-year survival of LTx recipients with ECMO support post-operatively were 74.6%, 54% and 36%, respectively. MOF was the predominant cause of death (58.3%) in patients on ECNIO support for PGD. Conclusions: Our data suggest that, in addition to prolonged ventilation and pharmacologic support, ECMO should be considered as a bridge to recovery from PGD in lung transplantation. Early institution of ECMO inay lead to diminished mortality in the setting of ALI despite the high incidence of MOF. Late institution of ECMO was associated with 100% mortality in this investigation.

Publication metadata

Author(s): Wigfield CH, Lindsey JD, Steffens TG, Edwards NM, Love RB

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2007

Volume: 26

Issue: 4

Pages: 331-338

ISSN (print): 1053-2498

ISSN (electronic): 1053-2498

Publisher: Elsevier Inc.

URL: http://dx.doi.org/10.1016/j.healun.2006.12.010

DOI: 10.1016/j.healun.2006.12.010

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