Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Ann Thorac Surg. 2023 May;115(5):1273-1280. doi: 10.1016/j.athoracsur.2022.12.038. Epub 2023 Jan 10.
Primary graft dysfunction (PGD) is the leading cause of death in the first 30 days after lung transplantation and is also associated with worse long-term outcomes. Outcomes of patients with PGD grade 3 requiring extracorporeal membrane oxygenation (ECMO) support after lung transplantation have yet to be well described. We sought to describe short- and long-term outcomes for patients with PGD grade 3 who required ECMO support.
This is a single-center retrospective cohort study of patients undergoing lung transplantation. We stratified patients with PGD grade 3 into non-ECMO, venoarterial (VA) ECMO, and venovenous (VV) ECMO groups after transplantation. We then compared the outcomes between the groups.
Of 773 lung transplant recipients, PGD grade 3 developed in 204 (26%) at any time in the first 72 hours after lung transplantation. Of these, 13 (5%) required VA ECMO and 25 (10%) required VV ECMO support. The 30-day, 1-year, and 5-year survival in the VA ECMO group was 62%, 54%, and 43% compared with 96%, 84%, and 65% in the VV ECMO group and 99%, 94%, and 71% in the non-ECMO group. Multivariable Cox regression analysis showed that VA ECMO was associated with increased mortality (hazard ratio, 2.37; 95% CI, 1.06-5.28; P = .04).
Patients who required VA ECMO support for PGD grade 3 have significantly worse survival compared with those who did not require ECMO and those who required VV ECMO support. This suggests that VA ECMO treatment of patients with PGD grade 3 after lung transplantation can be a predictable risk factor for mortality.
原发性移植物功能障碍（PGD）是肺移植后 30 天内死亡的主要原因，也与长期预后较差有关。接受肺移植后需要体外膜氧合（ECMO）支持的 PGD 3 级患者的预后尚未得到很好的描述。我们旨在描述需要 ECMO 支持的 PGD 3 级患者的短期和长期结局。
这是一项对接受肺移植的患者进行的单中心回顾性队列研究。我们将 PGD 3 级患者在移植后分为非 ECMO、静脉动脉（VA）ECMO 和静脉静脉（VV）ECMO 组。然后，我们比较了各组之间的结局。
在 773 例肺移植受者中，204 例（26%）在肺移植后 72 小时内任何时间发生 PGD 3 级。其中，13 例（5%）需要 VA ECMO，25 例（10%）需要 VV ECMO 支持。VA ECMO 组的 30 天、1 年和 5 年生存率分别为 62%、54%和 43%，而 VV ECMO 组分别为 96%、84%和 65%，非 ECMO 组分别为 99%、94%和 71%。多变量 Cox 回归分析显示，VA ECMO 与死亡率增加相关（危险比，2.37；95%置信区间，1.06-5.28；P=0.04）。
需要 VA ECMO 支持治疗 PGD 3 级的患者与未接受 ECMO 治疗的患者以及需要 VV ECMO 支持治疗的患者相比，生存率显著降低。这表明，VA ECMO 治疗肺移植后 PGD 3 级患者可能是死亡率的可预测危险因素。
