Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Heart Lung Transplant. 2020 Sep;39(9):915-925. doi: 10.1016/j.healun.2020.04.020. Epub 2020 Apr 29.
Over the past decade, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass (CPB) for cardiopulmonary support during lung transplantation at our institution. In this study, we present our experience using intraoperative ECMO in isolated lung transplantation and evaluate its impact on long-term graft function and survival.
All patients undergoing isolated lung transplantation with or without ECMO support between January 2010 and June 2019 were evaluated. Patients transplanted using CPB were excluded. Peri-operative and follow-up results from our database and patient charts were analyzed. Follow-up continued until September 1, 2019 (median, 3.34 years).
In total, 311 of 1,161 lung transplant recipients (27%) received intraoperative ECMO, with 24 (2%) patients further requiring CPB. None of the remaining 826 (71%) patients required intraoperative cardiopulmonary support. ECMO patients exhibited higher pre-transplant surgical risk profiles and endured more complicated early post-operative courses than those without ECMO (in-hospital mortality, 10.9% vs 2.3%; p < 0.001). Inevitably, this resulted in poorer overall graft survival among ECMO recipients (p = 0.0025). However, correcting for patients surviving to hospital discharge, no difference in survival between groups was observed (5-year survival, 71% vs 72%; p = 0.56). Similarly, freedom from chronic lung allograft dysfunction, biopsy-confirmed cellular rejection, or need for pulsed-steroid therapy did not differ between the groups (p = 0.99, p = 0.78, and p = 0.93, respectively).
Compared with patients not requiring cardiopulmonary support, ECMO recipients endured a more complicated peri-operative and early post-operative course. However, among those surviving to hospital discharge, no differences in long-term complications or outcomes were observed.
在过去十年中，我院在进行肺移植时，体外膜肺氧合（ECMO）已取代心肺转流（CPB）作为心肺支持。本研究介绍了我们在单纯肺移植中使用术中 ECMO 的经验，并评估了其对长期移植物功能和存活率的影响。
评估了 2010 年 1 月至 2019 年 6 月期间接受单纯肺移植且有或无 ECMO 支持的所有患者。排除了使用 CPB 进行移植的患者。从我们的数据库和患者病历中分析围手术期和随访结果。随访持续到 2019 年 9 月 1 日（中位数 3.34 年）。
总共 1161 例肺移植受者中有 311 例（27%）接受了术中 ECMO，其中 24 例（2%）患者进一步需要 CPB。其余 826 例（71%）患者中没有任何患者需要术中心肺支持。与无 ECMO 患者相比，ECMO 患者术前手术风险更高，术后早期经历了更复杂的病程（住院死亡率，10.9%比 2.3%；p<0.001）。这不可避免地导致 ECMO 受者的整体移植物存活率较差（p=0.0025）。然而，在校正存活至出院的患者后，两组之间的生存率没有差异（5 年生存率，71%比 72%；p=0.56）。同样，慢性肺移植物功能障碍、经活检证实的细胞排斥或脉冲类固醇治疗的无需要求也没有差异（p=0.99、p=0.78 和 p=0.93）。
与不需要心肺支持的患者相比，ECMO 受者经历了更复杂的围手术期和术后早期病程。然而，在校正存活至出院的患者后，在长期并发症或结局方面没有观察到差异。
