Effect of mode of intraoperative support on primary graft dysfunction after lung transplant

Gabriel Loor, Stephen Huddleston, Matthew Hartwig, Brandi Bottiger, Daoud Daoud, Qi Wei, Qianzi Zhang, Fabio Ius, Gregor Warnecke, Mauricio A. Villavicencio, Briana Tirabassi, Tiago Noguchi Machuca, Dirk Van Raemdonck, Anna Elisabeth Frick, Arne Neyrinck, Yoshiya Toyoda, Mohammed A. Kashem, Michelle Landeweer, Satish Chandrashekaran

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

OBJECTIVE: To clarify the relationship between the use of extracorporeal life support during lung transplantation and severe primary graft dysfunction (PGD), we developed and analyzed a novel multicenter international registry.

METHODS: The Extracorporeal Life Support in Lung Transplantation Registry includes double-lung transplants performed at 8 high-volume centers (>40/year). Multiorgan transplants were excluded. We defined severe PGD as grade 3 PGD (PGD3) observed 48 or 72 hours after reperfusion. Modes of support were no extracorporeal life support (off-pump), extracorporeal membrane oxygenation (ECMO), and cardiopulmonary bypass (CPB). To assess the association between mode of support and PGD3, we adjusted for demographic and intraoperative factors with a stepwise, mixed selection, multivariable regression model, ending with 10 covariates in the final model.

RESULTS: We analyzed 852 transplants performed between January 2016 and March 2020: 422 (50%) off-pump, 273 (32%) ECMO, and 157 (18%) CPB cases. PGD3 rates at time point 48-72 were 12.1% (51 out of 422) for off-pump, 28.9% for ECMO (79 out of 273), and 42.7% (67 out of 157) for CPB. The adjusted model resulted in the following risk profile for PGD3: CPB versus ECMO odds ratio, 1.89 (95% CI, 1.05-3.41; P = .033), CPB versus off-pump odds ratio, 4.24 (95% CI, 2.24-8.04; P < .001), and ECMO versus off-pump odds ratio, 2.24 (95% CI, 1.38-3.65; P = .001).

CONCLUSIONS: Venoarterial ECMO is increasingly used at high-volume centers to support complex transplant recipients during double-lung transplantation. This practice is associated with more risk of PGD3 than off-pump transplantation but less risk than CPB. When extracorporeal life support is required during lung transplantation, ECMO may be the preferable approach when feasible.

Original languageEnglish (US)
Pages (from-to)1351-1361.e4
JournalJournal of Thoracic and Cardiovascular Surgery
Volume164
Issue number5
DOIs
StatePublished - Nov 2022

Bibliographical note

Funding Information:
Dr Loor is on an advisory board for Impella and receives institutional grant support from Maquet , Transmedics , and Medtronic . All other authors reported no conflicts of interest.

Funding Information:
Funded by the American Association of Thoracic Surgeons (AATS) Graham Foundation. Dr Loor is on an advisory board for Impella and receives institutional grant support from Maquet, Transmedics, and Medtronic. All other authors reported no conflicts of interest.

Publisher Copyright:
© 2022 The American Association for Thoracic Surgery

Keywords

  • cardiopulmonary bypass
  • extracorporeal life support
  • extracorporeal membrane oxygenation
  • lung transplantation
  • outcomes
  • primary graft dysfunction

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

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