• J. Thorac. Cardiovasc. Surg. · Nov 2022

    Multicenter Study

    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, and Satish Chandrashekaran.
    • Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Tex; Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, Houston, Tex. Electronic address: Gabriel.loor@bcm.edu.
    • J. Thorac. Cardiovasc. Surg. 2022 Nov 1; 164 (5): 1351-1361.e4.

    ObjectiveTo 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.MethodsThe 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.ResultsWe 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).ConclusionsVenoarterial 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.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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