Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Semin Thorac Cardiovasc Surg. 2024;36(3):358-368. doi: 10.1053/j.semtcvs.2022.09.016. Epub 2023 Jan 28.
In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury biomarkers including syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve lung transplantation outcomes.
在肺移植中，与体外循环（CPB）相比，术中使用体外膜肺氧合（ECMO）可获得更好的术后结果。我们研究了术中支持策略对内皮损伤生物标志物和短期移植后结果的影响。纳入接受无支持、静脉-动脉（VA）ECMO 或 CPB 肺双侧移植的成年人。移植前后采集血浆样本，通过 Luminex 分析测量内皮损伤生物标志物，包括 syndecan-1（SYN-1）、细胞间黏附分子-1（ICAM-1）和基质金属蛋白酶-9。对 55 例患者进行分析。CPB 组患者到达重症监护病房时的 SYN-1 血浆水平明显高于 VA ECMO 组和无支持组（P < 0.01）。CPB 组、VA ECMO 组和无支持组的原发性移植物功能障碍 3 级（PGD3）发生率分别为 60.0%、40.1%和 15%（P=0.01）。72 小时发生 PGD3 的患者术后 SYN-1 和 ICAM-1 血浆水平明显升高。移植后发生急性肾损伤和肝功能障碍的患者 SYN-1 水平也明显升高。术后 SYN-1 到达重症监护病房是 PGD3、急性肾损伤和肝移植后肝功能障碍的显著预测生物标志物。CPB 与到达重症监护病房时 SYN-1 等内皮糖萼降解标志物的血浆浓度升高有关。SYN-1 水平升高是肺移植后终末器官功能障碍的预测指标。我们的数据表明，旨在调节内皮损伤的术中策略将有助于改善肺移植结果。
