Intraoperative extracorporeal membrane oxygenation for lung transplantation in cystic fibrosis patients: Predictors and impact on outcome

Scaravilli, Vittorio; Morlacchi, Letizia Corinna; Merrino, Alessandra; Piacentino, Edoardo; Marasco, Davide; Zanella, Alberto; Nosotti, Mario; Rosso, Lorenzo; Polli, Federico; Blasi, Francesco; Pesenti, Antonio; Grasselli, Giacomo

doi:10.1016/j.jcf.2019.10.016

Cited by 14 publications

(13 citation statements)

References 32 publications

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“…(3) missing medical records. A detailed description of the management of lung transplantation at our Institution can be found in previous reports [10][11][12] and in the Online Supplement (Additional Methods).…”

Section: Methodsmentioning

confidence: 99%

“…Cox-proportional hazard models were utilized to evaluate the effects of perioperative AKI and post-operative AKD upon survival. Clinically meaningful variables were included in the model as covariates, based on available literature (i.e., age [17], BMI [18], diabetes [19], gender [20], pulmonary hypertension [21], use of intraoperative ECMO [12], lung allocation score [22], and primary graft dysfunction [23]). Observations were right-censored.…”

Section: Statisticsmentioning

confidence: 99%

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Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure

et al. 2022

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Introduction The clinical trajectory of post-operative acute kidney injury (AKI) following lung transplantation for cystic fibrosis is unknown. Methods Incidence and risk factors for post-operative AKI, acute kidney disease (AKD) and chronic kidney disease (CKD) were retrospectively analyzed in cystic fibrosis patients undergoing lung transplantation. Logistic regressions, Chi-square, Cuzick rank tests, and Cox-proportional hazard models were used. Results Eighty-three patients were included. Creatinine peaked 3[2–4] days after transplantation, with 15(18%), 15(18%), and 20(24%) patients having post-operative AKI stages 1, 2, and 3, while 15(18%), 19(23%) and 10(12%) developed AKD stage 1, stage 2 and 3, respectively. Higher AKI stage was associated with worsening AKD (p = 0.009) and CKD (p = 0.015) stages. Of the 50 patients with AKI, 32(66%) transitioned to AKD stage > 0, and then 27 (56%) to CKD stage > 1. Female sex, extracorporeal membrane oxygenation support as a bridge to lung transplant and at the end of the surgery, the use of intraoperative blood components, and cold-ischemia time were associated with increased risk of post-operative AKI and AKD. Higher AKI stage prolonged invasive mechanical ventilation (p = 0.0001), ICU stay (p = 0.0001), and hospital stay (p = 0.0001), and increased the incidence of primary graft dysfunction (p = 0.035). Both AKI and AKD stages > 2 worsened long-term survival with risk ratios of 3.71 (1.34–10.2), p = 0.0131 and 2.65(1.02–6.87), p = 0.0443, respectively. Discussion AKI is frequent in cystic fibrosis patients undergoing lung transplantation, it often evolves to AKD and to chronic kidney disease, thereby worsening short- and long-term outcomes. Graphical abstract

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Section: Methodsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure

et al. 2022

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“…On the one hand, a common approach is to use ECMO only when required, to reduce the incidence of ECMO-related complications. Many high-volume centers have associated ECMO with poorer outcomes and a higher complication rate [ 46 , 47 , 48 , 49 , 50 ]. Intraoperative ECMO can be preoperatively planned or unplanned to face a hemodynamic or a respiratory failure despite optimal medical management.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the previous cited factors, we also found pulmonary fibrosis [ 52 ], and total lung capacity mismatch (downsizing) [ 48 ]. Scaravilli et al revealed that in an exclusive population of cystic fibrosis patients the risk factors were low right ventricle ejection, higher oxygen, low body surface area, and cystic fibrosis related diabetes [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Fessler

Finet

Fischler

et al. 2022

Life

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The management of lung transplant patients has continued to evolve in recent years. The year 2021 was marked by the publication of the International Consensus Recommendations for Anesthetic and Intensive Care Management of Lung Transplantation. There have been major changes in lung transplant programs over the last few years. This review will summarize the knowledge in anesthesia management of lung transplantation with the most recent data. It will highlight the following aspects which concern anesthesiologists more specifically: (1) impact of COVID-19, (2) future of transplantation for cystic fibrosis patients, (3) hemostasis management, (4) extracorporeal membrane oxygenation management, (5) early prediction of primary graft dysfunction, and (6) pain management.

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“…12 Twelve studies reported transfusion requirements in the context of mechanical circulatory support during transplant (Table 2). [20][21][22][23][24][25][26][27][28][29][30][31] Six of the studies were direct comparisons of cardiopulmonary bypass (CPB) versus veno-arterial extracorporeal membrane oxygenation (VA ECMO). [20][21][22]28,31,32 The remaining studies were a disparate group that…”

Section: Study Characteristicsmentioning

confidence: 99%

Blood product transfusion and lung transplant outcomes: A systematic review

Klapper

Ledbetter

Poisson

et al. 2021

Clinical Transplantation

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The perioperative transfusion of blood products has long been linked to development of acute lung injury and associated with mortality across both medical and surgical patient populations. 1,2 The need for blood product transfusion during and after lung transplantation is common and, in many instances, unavoidable. However, this practice may potentially be modifiable. 3 In this systematic review, we explore and summarize what is known regarding the impact of blood product transfusion on outcomes following lung transplantation, highlighting the most recent work in this area. Overall, the majority of the literature consists of single center retrospective analyses or the work of multicenter working groups referencing the same database. In the end, there are a number of remaining questions regarding blood product transfusion and their downstream effects on graft function and survival.

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Intraoperative extracorporeal membrane oxygenation for lung transplantation in cystic fibrosis patients: Predictors and impact on outcome

Cited by 14 publications

References 32 publications

Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure

Longitudinal assessment of renal function after lung transplantation for cystic fibrosis: transition from post-operative acute kidney injury to acute kidney disease and chronic kidney failure

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

Blood product transfusion and lung transplant outcomes: A systematic review

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