Effect of intraoperative support mode on circulating inflammatory biomarkers after lung transplantation surgery

Chacon‐Alberty, Lourdes; Ye, Shengbin; Elsenousi, Abdussalam E.; Hills, Emma; King, Madelyn; D'vya, Ethan; Leon, Andres Pena; Salan-Gomez, Marcelo; Li, Meng; Hochman-Mendez, Camila; Loor, Gabriel

doi:10.1111/aor.14474

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…While Hoetzenecker and colleagues relate a low PGD incidence to standard VA-ECMO use, Loor and colleagues recently published a multicenter international registry showing an association between PGD and VA-ECMO ( 15 , 16 ). Furthermore, a recent single-center prospective observational study showed that levels of post-operative circulating cytokines were significantly higher in ECLS group compared to off-pump group and associated with endothelial cell dysfunction and PGD ( 49 ). On the other hand, another recent single-center retrospective study reports on lower leukocyte margination in post-reperfusion biopsies in ECMO group compared to off-pump ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

Complications related to extracorporeal life support in lung transplantation: single-center analysis

Orlitová,

Goos,

Van Slambrouck

et al. 2023

J Thorac Dis

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Background Extracorporeal life support (ECLS) is not routinely used at our center during sequential single-lung transplantation (LTx), but is restricted to anticipate and overcome hemodynamic and respiratory problems occurring peri-operatively. In this retrospective descriptive cohort study, we aim to describe our single-center experience with ECLS in LTx, analyzing ECLS-related complications. Methods All transplantations with peri-operative ECLS use [2010–2020] were retrospectively analyzed. Multi-organ and heart-lung transplantation were excluded. Demographics, support type and indications are described. Complications are categorized according to the underlying nature and type. Data are presented as median [interquartile range (IQR)]. Kaplan-Meier was used for survival analysis. Results The overall use of ECLS was 22% (156/703 patients) with a mean age of 52 years (IQR, 36–59 years). Transplant indications in ECLS cohort were interstitial lung disease (38%; n=60), chronic obstructive pulmonary disease (COPD) (19%; n=29), cystic fibrosis (17%; n=26) and others (26%; n=41). Per indication, 94% (15/16) of pulmonary arterial hypertension patients required ECLS, whereas only 8% (29/382) of COPD patients did. In 16% (25/156) of supported patients, veno-venous extracorporeal membrane oxygenation was initiated, while 77% (120/156) required veno-arterial support, and 7% (11/156) cardiopulmonary bypass. Thirty-day mortality was 6% (9/156). Sixteen percent (25/156) of patients were bridged to transplantation on ECLS and 24% (37/156) required post-operative support. Main reasons to use ECLS were intra-operative hemodynamic instability (53%; n=82), ventilation/oxygenation problems (22%; n=34) and reperfusion edema (17%; n=26). Overall incidence of patients with at least one ECLS-related complication was 67% (n=104). Most common complications were hemothorax (25%; n=39), need for continuous renal replacement therapy (19%; n=30), and thromboembolism (14%; n=22). Conclusions ECLS was required in 22% of LTxs, with a reported ECLS-related complication rate of 67%, of which the most common was hemothorax. Larger databases are needed to further analyze complications and develop tailored deployment strategies for ECLS-use in LTx.

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Section: Discussionmentioning

confidence: 99%

Complications related to extracorporeal life support in lung transplantation: single-center analysis

Orlitová,

Goos,

Van Slambrouck

et al. 2023

J Thorac Dis

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“…Of these, 35, mainly congress abstracts were removed, and 42 were evaluated for eligibility. Further 15 articles (22,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)36,53,55,57) were excluded, with nine, five, and one failing to meet the predefined outcome, intervention, and population criteria, respectively (see Table S1, Online Supplement, Additional Results for further details). Furthermore, two articles (22,45) presented duplicate data of previously included studies (40,60) and were consequently removed from the analysis.…”

Section: Search Selection and Study Characteristicsmentioning

confidence: 99%

Early serum biomarkers to characterise different phenotypes of primary graft dysfunction after lung transplantation: a systematic scoping review

Scaravilli,

Turconi,

Colombo

et al. 2024

ERJ Open Res

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BackgroundLung transplantation (LUTX) often is complicated by primary graft dysfunction (PGD). Plasma biomarkers hold potential for PGD phenotyping and targeted therapy. This scoping review aims to collect the available literature in search of serum biomarkers for PGD phenotyping.MethodsFollowing JBI and PRISMA guidelines, we conducted a systematic review searching MEDLINE, Web of Science, EMBASE, and The Cochrane Library for papers reporting the association between serum biomarkers measured within 72 h of reperfusion and PGD, following ISHLT guidelines. We extracted study details, patient demographics, PGD definition and timing, biomarker concentration, and their performance in identifying PGD cases.ResultsAmong the 1050 papers screened, 25 prospective observational studies were included, with only 9 conducted in the last decade. These papers included 1793 unique adult patients (1195 double LUTX, median study size 100 (IQR 44–119). Most (n=21) compared PGD grade 3 to less severe PGD, but only 4 adhered to 2016 PGD definitions. Enzyme-linked immunosorbent assays and the multiplex bead array technique were utilised in 23 and 2 papers, respectively. In total, 26 candidate biomarkers were identified, comprising 13 inflammatory, 3 endothelial activation, 3 epithelial injury, 3 cellular damage, 2 coagulation dysregulation markers. Only 5 biomarkers (sRAGE, ICAM-1, PAI-1, SP-D, FSTL-1) underwent AUROCC analysis, yielding a median value of 0.58 (0.51, 0.78) in 406 patients (276 double LUTX).ConclusionsSeveral biomarkers exhibit promise for future studies aimed at PGD phenotyping after LUTX. To uncover the significant existing knowledge gaps, further international prospective studies incorporating updated diagnostic criteria, modern platforms, and advanced statistical approaches are essential.

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The hemodynamic interplay between pulmonary ischemia-reperfusion injury and right ventricular function in lung transplantation: a translational porcine model

Orlitová,

Verbelen,

Frick

et al. 2023

American Journal of Physiology-Lung Cellular and Molecular Phys

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Lung transplantation is a challenging procedure. Following the process of ischemia-reperfusion injury, the transplanted pulmonary graft might become severely damaged, resulting in primary graft dysfunction. Additionally, during the intra-operative window, the right ventricle is at risk of acute failure. The interaction of right ventricular function with lung injury, is however, poorly understood. We aimed to address this interaction in a translational porcine model of pulmonary ischemia-reperfusion injury. Advanced pulmonary and hemodynamic assessment was used, including right ventricular pressure-volume loop analysis. The acute model was based on clamping and unclamping of the left lung hilus, respecting the different hemodynamic phases of a clinical lung transplantation. We found that forcing entire right ventricular cardiac output through a lung suffering from ischemia-reperfusion injury increased afterload (pulmonary vascular resistance from baseline to end experiment p <0.0001) and induced right ventricular failure in 5/9 animals. Notably, we identified different compensation patterns in failing versus non-failing ventricles (arterial elastance p=0.0008; stroke volume p <0.0001). Furthermore, increased vascular pressure and flow produced by the right ventricle resulted in higher pulmonary injury, as measured by ex-vivo CT density (correlation: pressure r=0.8; flow r= 0.85). Finally, RV ischemia as measured by troponin-T was negatively correlated with pulmonary injury (r=-0.76), however, troponin-T values did not determine RVF in all animals. In conclusion, we demonstrate a delicate balance between development of pulmonary ischemia-reperfusion injury and right ventricular function during lung transplantation. Furthermore, we provide a physiological basis for potential benefit of extracorporeal life support technology.

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Effect of intraoperative support mode on circulating inflammatory biomarkers after lung transplantation surgery

Cited by 4 publications

References 32 publications

Complications related to extracorporeal life support in lung transplantation: single-center analysis

Complications related to extracorporeal life support in lung transplantation: single-center analysis

Early serum biomarkers to characterise different phenotypes of primary graft dysfunction after lung transplantation: a systematic scoping review

The hemodynamic interplay between pulmonary ischemia-reperfusion injury and right ventricular function in lung transplantation: a translational porcine model

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