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Effect of mode of intraoperative support on primary graft dysfunction after lung transplant
Loor, Gabriel Huddleston, Stephen Hartwig, Matthew Bottiger, Brandi Daoud, Daoud Wei, Qi Zhang, Qianzi Ius, Fabio Warnecke, Gregor Villavicencio, Mauricio A.
Loor, Gabriel
Huddleston, Stephen
Hartwig, Matthew
Bottiger, Brandi
Daoud, Daoud
Wei, Qi
Zhang, Qianzi
Ius, Fabio
Warnecke, Gregor
Villavicencio, Mauricio A.
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Journal article
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2022-10-14
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Surgery
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http://dx.doi.org/10.1016/j.jtcvs.2021.10.076
Abstract
Objective: To clarify the relationship between the use of extracorporeal life support during lung transplantation and severe primary graft dysfunction (PGD), we developed and analyzed a novel multicenter international registry. Methods: The Extracorporeal Life Support in Lung Transplantation Registry includes double-lung transplants performed at 8 high-volume centers (>40/year). Multiorgan transplants were excluded. We defined severe PGD as grade 3 PGD (PGD3) observed 48 or 72 hours after reperfusion. Modes of support were no extracorporeal life support (off-pump), extracorporeal membrane oxygenation (ECMO), and cardiopulmonary bypass (CPB). To assess the association between mode of support and PGD3, we adjusted for demographic and intraoperative factors with a stepwise, mixed selection, multivariable regression model, ending with 10 covariates in the final model. Results: We analyzed 852 transplants performed between January 2016 and March 2020: 422 (50%) off-pump, 273 (32%) ECMO, and 157 (18%) CPB cases. PGD3 rates at time point 48-72 were 12.1% (51 out of 422) for off-pump, 28.9% for ECMO (79 out of 273), and 42.7% (67 out of 157) for CPB. The adjusted model resulted in the following risk profile for PGD3: CPB versus ECMO odds ratio, 1.89 (95% CI, 1.05-3.41; P = .033), CPB versus off-pump odds ratio, 4.24 (95% CI, 2.24-8.04; P < .001), and ECMO versus off-pump odds ratio, 2.24 (95% CI, 1.38-3.65; P = .001). Conclusions: Venoarterial ECMO is increasingly used at high-volume centers to support complex transplant recipients during double-lung transplantation. This practice is associated with more risk of PGD3 than off-pump transplantation but less risk than CPB. When extracorporeal life support is required during lung transplantation, ECMO may be the preferable approach when feasible.
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Citation
Gabriel Loor, Stephen Huddleston, Matthew Hartwig, Brandi Bottiger, Daoud Daoud, Qi Wei, Qianzi Zhang, Fabio Ius, Gregor Warnecke, Mauricio A. Villavicencio, Briana Tirabassi, Tiago Noguchi Machuca, Dirk Van Raemdonck, Anna Elisabeth Frick, Arne Neyrinck, Yoshiya Toyoda, Mohammed A. Kashem, Michelle Landeweer, Satish Chandrashekaran, Effect of mode of intraoperative support on primary graft dysfunction after lung transplant, The Journal of Thoracic and Cardiovascular Surgery, Volume 164, Issue 5, 2022, Pages 1351-1361.e4, ISSN 0022-5223,
https://doi.org/10.1016/j.jtcvs.2021.10.076.
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Elsevier
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The Journal of Thoracic and Cardiovascular Surgery (JTCVS), Vol. 164, Iss. 5
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