Ikeda Masaki, Aoyama Akihiro, Fukuyama Junya, Okuda Masanori, Yamazaki Kazuhiro, Minatoya Kenji, Chen-Yoshikawa Toyofumi F, Kayawake Hidenao, Tanaka Satona, Yamada Yoshito, Yutaka Yojiro, Ohsumi Akihiro, Nakajima Daisuke, Hamaji Masatsugu, Date Hiroshi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto-Katsura Hospital, Kyoto, Japan.
JHLT Open. 2024 Feb 15;4:100070. doi: 10.1016/j.jhlto.2024.100070. eCollection 2024 May.
Extracorporeal membrane oxygenation (ECMO) has been frequently used instead of cardiopulmonary bypass (CPB) as extracorporeal circulatory support during cadaveric lung transplantation. This study compared the outcomes of intraoperative CPB or ECMO in living-donor lobar lung transplantation (LDLLT).
CPB and ECMO were performed in 23 and 53 patients, respectively, who underwent initial bilateral LDLLT in our institution from 2008 to 2019. We retrospectively compared the short- and long-term outcomes between the 2 groups.
Patient background, graft size-matching data, operation time, extracorporeal circulation time, and bleeding amount were not significantly different in the 2 groups. However, the CPB group required more transfusion than the ECMO group (6,860 vs 3,840 ml, respectively; = 0.002). The rate of increase in body weight through LDLLT was 7.4% and 4.9% in CPB and ECMO groups, respectively = 0.040), and primary graft dysfunction scores were significantly worse in the CPB group. Postoperative ECMO support was required in 4 cases, and hospital death occurred in 1 patient exclusively in the CPB group. Chronic lung allograft dysfunction (CLAD) was diagnosed in 43.5% and 17.0% of patients in the CPB and ECMO groups, respectively ( = 0.021), and the 5-year CLAD-free survival was 55.8% and 72.7% of patients, respectively ( = 0.013).
Intraoperative ECMO reduced primary graft dysfunction, possibly due to the lower requirement for intraoperative transfusion and less intraoperative weight gain causing systemic edema. The beneficial effect of ECMO in the early phase may result in less CLAD development in the long-term follow-up after LDLLT.
在尸体肺移植过程中，体外膜肺氧合（ECMO）已被频繁用于替代体外循环（CPB）作为体外循环支持。本研究比较了活体供体肺叶移植（LDLLT）中术中CPB或ECMO的结果。
2008年至2019年在本机构接受初次双侧LDLLT的患者中，分别有23例和53例接受了CPB和ECMO。我们回顾性比较了两组的短期和长期结果。
两组患者的背景、移植物大小匹配数据、手术时间、体外循环时间和出血量无显著差异。然而，CPB组比ECMO组需要更多的输血（分别为6860 vs 3840 ml；P = 0.002）。通过LDLLT体重增加率在CPB组和ECMO组分别为7.4%和4.9%（P = 0.040），CPB组的原发性移植物功能障碍评分明显更差。4例患者术后需要ECMO支持，仅CPB组有1例患者发生医院死亡。CPB组和ECMO组分别有43.5%和17.0%的患者被诊断为慢性肺移植功能障碍（CLAD）（P = 0.021），5年无CLAD生存率分别为55.8%和72.7%的患者（P = 0.013）。
术中ECMO减少了原发性移植物功能障碍，可能是由于术中输血需求较低以及术中体重增加较少导致全身水肿。ECMO在早期的有益作用可能导致LDLLT长期随访中CLAD的发生率较低。
