Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation

Hayes, Don; Whitson, Bryan A.; Black, Sylvester M.; Preston, Thomas J.; Papadimos, Thomas J.; Tobias, Joseph D.

doi:10.1016/j.healun.2014.12.014

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…In the present study, we observed that the intraoperative ECMO support was more likely to be required in older recipients. Age has been a wellknown prognostic factor for lung transplantation and several studies have shown that age was significantly correlated with ECMO support in other disease [16][17][18]. In addition to age, we found that the duration of mechanical ventilation before operation and higher preoperative APA-CHE II scores were also associated with ECMO support during lung transplantation, which suggests that patients requiring pre-transplant mechanical ventilation and had higher preoperative APACHE II scores should be considered for ECMO support.…”

Section: Discussionsupporting

confidence: 58%

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Zhang

Sang

et al. 2020

Respir Res

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Background: Intraoperative Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as lifesupport for lung transplantation patients. However, factors associated with this procedure in lung transplantation patients have not yet been characterized. The aim of this study was to identify preoperative factors of intraoperative ECMO support during lung transplantation and to evaluated the outcome of lung transplantation patients supported with ECMO. Methods: Patients underwent lung transplantation treated with and without ECMO in Guangzhou Institute of Respiratory Diseases between January 2015 to August 2018 were retrospectively reviewed. Patient demographics and clinical variables were collected and analyzed. Multivariate logistic regression was performed to identify factors independently associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. Results: During the study period, 138 patients underwent lung transplantation at our institution, the mean LAS was (56.63 ± 18.39) (range, 32.79 to 88.70). Fourty four patients were treated with veno-venous/veno-arterial ECMO. Among the patients, 32 patients wean successfully ECMO after operation, 12 patients remain ECMO after operation, and 32 patients (62.74%) survived to hospital discharge. In multiple analysis, the following factors were associated with intraoperative ECMO support: advanced age, high PAP before operation, duration of mechanical ventilation before operation, a higher APACHE II and primary diagnosis for transplantation. The overall survival rates at 1, 3, and 12 months were 90. 91, 72.73, and 56.81% in the ECMO group, and 95.40, 82.76, and 73.56% in the non-ECMO group, respectively (log-rank P = 0.081). Patients who underwent single lung transplant had a lower survival rates in ECMO group as compared with non-ECMO group at 1, 3, and 12 months (90.47% vs 98.25, 71.43% vs 84.21, and 52.38% vs 75.44%) (log-rank P = 0.048). Conclusions: The preoperative factors of intraoperative ECMO support during lung transplantation included age, high PAP before operation, preoperative mechanical ventilation, a higher APACHE II and primary diagnosis for transplantation based on multivariate analysis.

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Section: Discussionsupporting

confidence: 58%

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Zhang

Sang

et al. 2020

Respir Res

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“…An evolving experience with ambulatory ECMO has demonstrated that this approach can be used to avoid deconditioning and allow patients to be ambulatory while awaiting organ offers and transplantation 28 – 32 , and using ambulatory ECMO has recently been shown to have economic advantages over non-ambulatory ECMO 33 . Recent queries of the UNOS database have shown that while the use of ECMO had an adverse impact on survival for older patients, a negative effect was not demonstrated for a subgroup of younger patients under 40 years of age 34 , and when used in high-volume transplant centers, ECMO use did not appear to increase the risk of post-transplant mortality 35 .…”

Section: Bridging To Transplantationmentioning

confidence: 99%

Recent advances in lung transplantation

Meyer

2018

F1000Res

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Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.

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“…87,88,90,91 However, in most series posttransplant survival is inversely correlated to duration of ECMO support 87,88 and timely access to successful lung xenografts might substantially shorten the duration of ECMO support and improve outcomes.…”

Section: Tablementioning

confidence: 99%

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

et al. 2017

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Several groups have reported extended survival of genetically-engineered pig organs in nonhuman primates, varying from almost 10 months for life-supporting kidney grafts and >2 years for nonlife-supporting heart grafts to less than 1 month for life-supporting liver and lung grafts. We have attempted to define groups of patients who may not have an option to wait for an allograft. These include kidney, heart, and lung candidates who are highly-allosensitized. In addition, some kidney candidates (who have previously lost at least 2 allografts from rapid recurrence of native kidney disease) have a high risk of further recurrence and will not be offered a repeat allotransplant. Patients with complex congenital heart disease, who may have undergone previous palliative surgical procedures, may be unsuitable for ventricular assist device implantation. Patients dying of fulminant hepatic failure, for whom no alternative therapy is available, may be candidates for a pig liver, even if only as a bridge until an allograft becomes available. When the results of pig organ xenotransplantation in nonhuman primates suggest a realistic potential for success of a pilot clinical trial, highly-selected patients should be offered participation.

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Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation

Cited by 20 publications

References 25 publications

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Factors associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation

Recent advances in lung transplantation

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation

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