Kim Jin Sun, Fleitas Sosa Derlis, Munshi Rezwan, Criner Gerard, Anjum Fatima
Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina.
JHLT Open. 2024 Apr 24;5:100096. doi: 10.1016/j.jhlto.2024.100096. eCollection 2024 Aug.
The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has increased over time. While 1-year and overall survival have been reported to be similar with non-ECMO transplant recipients, there are limited data on major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB) events. In this study, we sought to evaluate the incidence of perioperative MACCE and CRB in lung transplant recipients who underwent ECMO BTT.
Using the National Inpatient Sample from 2008-2019, we identified 5,254 lung transplant recipients who either received or did not require pretransplant ECMO. Perioperative MACCE and CRB were compared between the 2 cohorts.
Patients with ECMO BTT had a higher incidence of MACCE compared to non-ECMO patients (35% vs 13.3%, < 0.0001) and CRB (34.5% vs 12.9%, < 0.0001). Recipients of pretransplant ECMO for double lung transplant ( = 158) were more likely to have perioperative MACCE and CRB as opposed to patients without pretransplant ECMO ( = 3,584) (adjusted odds ratio 2.69, < 0.0001; 95% confidence interval 1.86-3.80). The ECMO BTT cohort was notably younger with less cardiac comorbidities and higher diagnoses of cystic fibrosis and interstitial lung disease.
Our data indicate that lung transplant recipients who required ECMO BTT are at significantly higher risk of MACCE and bleeding events despite being younger with less comorbidities as opposed to those who did not require ECMO.
随着时间的推移，体外膜肺氧合（ECMO）作为肺移植（BTT）桥梁的应用有所增加。虽然据报道，非ECMO移植受者的1年生存率和总生存率相似，但关于主要不良心血管和脑血管事件（MACCE）以及临床相关出血（CRB）事件的数据有限。在本研究中，我们试图评估接受ECMO BTT的肺移植受者围手术期MACCE和CRB的发生率。
利用2008 - 2019年的全国住院患者样本，我们确定了5254名接受或不需要移植前ECMO的肺移植受者。比较了这两个队列的围手术期MACCE和CRB情况。
与非ECMO患者相比，接受ECMO BTT的患者MACCE发生率更高（35%对13.3%，<0.0001），CRB发生率也更高（34.5%对12.9%，<0.0001）。接受双肺移植前ECMO的受者（n = 158）比未接受移植前ECMO的患者（n = 3584）更有可能发生围手术期MACCE和CRB（调整后的优势比为2.69，<0.0001；95%置信区间为1.86 - 3.80）。接受ECMO BTT的队列明显更年轻，心脏合并症较少，囊性纤维化和间质性肺病的诊断率更高。
我们的数据表明，需要ECMO BTT的肺移植受者发生MACCE和出血事件的风险显著更高，尽管他们比不需要ECMO的受者更年轻且合并症更少。
