Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Chapel Hill, Chapel Hill, North Carolina.
Department of Cardiothoracic Surgery, Division of Lung Transplantation, University of Pittsburgh, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2021 Oct;112(4):1083-1088. doi: 10.1016/j.athoracsur.2020.08.083. Epub 2020 Nov 18.
There is a reluctance to using extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation in the pediatric population. Pediatric patients between ages 12 and 18 years are eligible for acuity-based lung transplantation using the Lung Allocation Score and may be suitable for adult allografts, increasing the donor pool and thus leading to a successful bridge to lung transplantation.
The United Network for Organ Sharing dataset was queried for primary lung transplantation in pediatric patients (12-18 years) from 2005 to 2016. Groups were divided into those who were on ECMO (bridged [BG]) and not on ECMO (nonbridged [NBG]) at the time of listing for lung transplant.
The groups comprised 16 BG and 375 NBG patients. Fourteen BG patients (88%) survived the first 30 days. One-year (83.3% vs 86.2%, P = .78) and 3-year (66.7% vs 55.1%, P = .57) survivals were similar in the BG and NBG groups, respectively. Donors in the BG group were more likely to be adults. The median wait-list times were shorter (10.5 [interquartile range {IQR}, 11] vs 93 [IQR, 221] days, P < .001), with a higher Lung Allocation Score (89.8 vs 36.6, P < .001) and similar median ischemic times (5.19 [IQR, 2.32] vs 5.34 [IQR, 1.92] hours, P = .85) in the BG group compared with the NBG group. The median post-transplant length of stay was longer in the BG group (33 [IQR, 31] vs 17 [IQR, 12] days, P = .007) and was the only factor predictive of 3-year mortality. Longer wait-list time had a higher mortality in the BG group.
ECMO as a bridge to lung transplantation is a reasonable strategy in pediatric patients aged ≥ 12 years with acceptable operative mortality and similar 1- and 3-year survival compared with nonbridged patients despite higher acuity. Bridged patients were more likely to receive adult donor lungs.
在儿科人群中，将体外膜氧合（ECMO）作为肺移植桥接治疗的方法并不常用。12 至 18 岁的儿科患者可根据病情严重程度使用肺分配评分接受肺移植，并可能适合接受成人供体肺，从而增加供体库，从而成功实现肺移植桥接治疗。
本研究在美国器官共享联合网络（UNOS）数据库中查询了 2005 年至 2016 年期间接受肺移植的 12-18 岁儿科患者的初次肺移植数据。将患者分为 ECMO 桥接组（BG）和非 ECMO 桥接组（NBG）。
该研究共纳入 16 例 BG 患者和 375 例 NBG 患者。14 例 BG 患者（88%）在术后 30 天内存活。BG 组和 NBG 组患者的 1 年生存率（83.3% vs 86.2%，P=0.78）和 3 年生存率（66.7% vs 55.1%，P=0.57）相似。BG 组供者更可能为成人。BG 组的中位等待时间更短（10.5[四分位距 {IQR}，11] vs 93[IQR，221]天，P<0.001），肺分配评分更高（89.8 vs 36.6，P<0.001），缺血时间相似（5.19[IQR，2.32] vs 5.34[IQR，1.92]小时，P=0.85）。BG 组患者术后中位住院时间较长（33[IQR，31] vs 17[IQR，12]天，P=0.007），是预测 3 年死亡率的唯一因素。BG 组患者等待时间较长时，死亡率较高。
对于 12 岁及以上的儿科患者，ECMO 作为肺移植桥接治疗是一种合理的策略，其手术死亡率可接受，与非桥接患者相比，1 年和 3 年生存率相似，尽管病情更严重。桥接患者更可能接受成人供体肺。
