Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass for Lung Transplantation

Heid, Christopher A.; Khoury, Mitri K.; Maaraoui, Kayla; Liu, C.; Peltz, Matthias; Wait, Michael A.; Ring, W. Steves; Huffman, Lynn C.

doi:10.1016/j.jss.2020.05.072

Cited by 12 publications

(7 citation statements)

References 30 publications

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“…Single LT are performed by anterolateral or posterolateral thoracotomy, depending on surgeon preference. Institutional preference is to use cardiopulmonary bypass selectively when intraoperative physiology mandates 8 . Postoperatively, patients are recovered in the intensive care unit under the shared care of transplant pulmonology and cardiothoracic surgery services.…”

Section: Methodsmentioning

confidence: 99%

“…Institutional preference is to use cardiopulmonary bypass selectively when intraoperative physiology mandates. 8 Postoperatively, patients are recovered in the intensive care unit under the shared care of transplant pulmonology and cardiothoracic surgery services. Induction immunosuppression is completed using a three-drug regimen: solumedrol, azathioprine, and either basiliximab or tacrolimus, depending on patient factors.…”

Section: Institutional Practice Patternsmentioning

confidence: 99%

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Impact of cerebrovascular accidents on lung transplant survival

Kalsbeek

Chuckaree

Khoury

et al. 2022

Journal of Cardiac Surgery

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Background: Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival. Methods: A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed.Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time.Results: The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044).Conclusions: Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.

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Section: Methodsmentioning

confidence: 99%

Section: Institutional Practice Patternsmentioning

confidence: 99%

Impact of cerebrovascular accidents on lung transplant survival

Kalsbeek

Chuckaree

Khoury

et al. 2022

Journal of Cardiac Surgery

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“…Despite the clear indication for intraoperative support, CPB's use has also considered a risk factor for PGD (10) and suboptimal outcomes (37). CPB is also associated with injury to other organ systems, like renal (38) and neurological (39).…”

Section: Cpbmentioning

confidence: 99%

Intraoperative support during lung transplantation

Santos¹,

D’Cunha²

2021

J Thorac Dis

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The role of intraoperative mechanical support during lung transplantation (LTx) is essential to provide a safe hemodynamic and ventilatory status during critical intraoperative events. This hemodynamic and ventilatory stability is vital to minimize the odds of suboptimal outcomes, especially considering that, due to the scarcity of donors and the fact that more and more patients with significant comorbidities are being considered for this therapy, a more aggressive approach is often needed by the transplant centers.Hence, the attenuation of any potential injury that can happen during this complex event is paramount.While a thorough assessment of the donor and optimization of postoperative care is pursued, certainly protective intraoperative management would also contribute to better outcomes. Understanding each patient's underlying anatomy and cardiopulmonary physiology, associated with awareness of critical events during a complicated procedure like LTx, is essential for a precise indication and safe use of support.Cardiopulmonary bypass (CPB) and veno-arterial extracorporeal membrane oxygenation (VA ECMO) have been the most common approaches used, with the latter gaining popularity more recently and we have used VA ECMO exclusively for the last decade. New technologies certainly contributed to more liberal use of VA ECMO intraoperatively, enabling a protecting and physiologic environment for the newly implanted grafts.In this setting, potential prophylactic use for lung protection during a critical period is also considered.

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“…There continues to be debate on the role of MCS perioperatively on outcomes in lung transplantation. A retrospective single-site study by Heid et al 38 showed an increase in acute kidney injury and 30-day mortality for patients who had transplant on cardiopulmonary bypass versus without cardiopulmonary bypass. Separately, a prospective, observational study by Hoetzenecker et al 39 demonstrated that routine use of intraoperative central VA-ECMO had excellent rates of primary graft function (PGD) 24 hours after transplantation, with 38.4% patients already extubated, 48.4% of patients classified as PGD0, 4.4% of patients as PGD1, 3.1% as PGD2, and 2.5% as PGD3.…”

Section: Lung Transplantationmentioning

confidence: 99%

Year in Review 2020: Noteworthy Literature in Cardiothoracic Critical Care

Gilliland

Tran

Alber

et al. 2021

Semin Cardiothorac Vasc Anesth

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This year will be forever marked by the drastic changes COVID-19 wrought on our personal and professional lives. New roles and challenges in critical care have forced us to be constantly nimble and flexible in how we approach medicine. The strain of these challenges is apparent throughout the health care community and our society as a whole. Despite this adversity, 2020 will also be remembered for fantastic advances in research. This article is a collection of influential and exciting studies published in 2020 encompassing a broad swath of critical care with a focus on cardiothoracic critical care. Themes include examinations of early extracorporeal membrane oxygenation support for out-of-hospital cardiac arrest patients, the impact of sedation and other risk factors on perioperative mortality, a novel fluid resuscitation strategy following cardiac surgery, and advances in the fields of heart and lung transplantation as well as how they were affected by COVID-19. Given that many cardiothoracic intensivists were redeployed to the care of SARS-CoV-2 patients, we also discuss important advances in therapeutics for the virus.

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Acute Kidney Injury in Patients Undergoing Cardiopulmonary Bypass for Lung Transplantation

Cited by 12 publications

References 30 publications

Impact of cerebrovascular accidents on lung transplant survival

Impact of cerebrovascular accidents on lung transplant survival

Intraoperative support during lung transplantation

Year in Review 2020: Noteworthy Literature in Cardiothoracic Critical Care

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