Clinical lung and heart/lung transplantationEarly Institution of Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Lung Transplantation Improves Outcome
Section snippets
Methods
A single-center analysis of 297 consecutive lung transplants (LTx) at the University of Wisconsin Hospital was performed. Retrospective analysis of UNOS data sheets and clinical case documentation was conducted for all primary single and bilateral LTxs. Patients with severe PGD, Grade 3 according to ISHLT guidelines,5 and subsequent ECMO were compared with an unaffected LTx cohort. For the evaluation of outcomes the patient cohort was divided into two groups: early institution of ECMO (<24
Patient Demographics
Twenty-two patients, 7.9%, had severe PGD (ISHLT Grade 3) requiring ECMO support due to refractory hypoxemia after lung transplantation (male-to-female ratio: 1.2:1). The primary pulmonary diagnoses of recipients leading to end-stage respiratory failure prior to transplantation are shown in Table 1, Table 2. Eleven of these patients were single-lung transplant (SLTx) recipients, 8 bilateral lung transplants (BLTx), 1 heart–lung transplant (HLTx), 1 patient was an SLTx who was placed on ECMO as
Discussion
The renewed interest in the application of ECMO for potentially reversible causes of respiratory failure has coincided with the refined technology and innovative ventilator strategies developed in the 1990s. The primary principle in this approach is to provide membrane oxygenation as a temporary replacement measure to allow for intrinsic mechanisms to repair the diffuse alveolar damage in a non-proliferative stage of acute lung injury. Although conceptually appealing, ECMO after lung
References (19)
- et al.
Registry of the International Society for Heart and Lung Transplantation: eighth official pediatric report—2005
J Heart Lung Transplant
(2005) - et al.
Extracorporeal membrane oxygenation after lung transplantation: evolving technique improves outcomes
Ann Thorac Surg
(2004) - et al.
Report of the ISHLT Working Group on Primary Lung Graft DysfunctionPart II: Definition. A consensus statement of the International Society for Heart and Lung Transplantation
J Heart Lung Transplant
(2005) - et al.
A review of lung transplant donor acceptability criteria
J Heart Lung Transplant
(2003) - et al.
Independent ventilation and ECMO for severe unilateral pulmonary edema after SLT for primary pulmonary hypertension
Chest
(1995) - et al.
Early experience with adult extracorporeal membrane oxygenation in the modern era
Ann Thorac Surg
(1992) - et al.
Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation
Ann Thorac Surg
(2005) - et al.
Medium-term results of extracorporeal membrane oxygenation for severe acute lung injury after lung transplantation
J Heart Lung Transplant
(2004) - et al.
A randomized, placebo-controlled trial of complement inhibition in ischemia–reperfusion injury after lung transplantation in human beings
J Thorac Cardiovasc Surg
(2005)
Cited by (92)
Postreperfusion Pulmonary Artery Pressure Indicates Primary Graft Dysfunction After Lung Transplant
2024, Annals of Thoracic SurgeryVenoarterial or Venovenous Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction After Lung Transplant?
2023, Annals of Thoracic SurgeryPrimary graft dysfunction grade 3 following pediatric lung transplantation is associated with chronic lung allograft dysfunction
2023, Journal of Heart and Lung TransplantationThe International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support
2023, Journal of Heart and Lung TransplantationCritical Care Management of the Lung Transplant Recipient
2023, Clinics in Chest Medicine