Extracorporeal Life Support as Bridge to Lung Retransplantation: A Multicenter Pooled Data Analysis

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• 作者：Sté ; phane Collaud ; MD ; MS^a ; Christian Benden ; MD^b ; Christoph Ganter ; MD^c ; Sven Hillinger ; MD^a ; Isabelle Opitz ; MD^a ; Didier Schneiter ; MD^a ; Reto Schuepbach ; MD^d ; Ilhan Inci ; MD^a ; Walter Weder ; MD^a ; ^{walter.weder@usz.ch" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AV ; arteriovenous ; BOS ; bronchiolitis obliterans syndrome ; CI ; confidence interval ; DLC ; double-lumen cannula ; ECLS ; extracorporeal life support ; ECMO ; extracorporeal membrane oxygenation ; ECCO2R ; extracorporeal carbon dioxide removal ; HR ; hazard ratio ; IMV ; invasive mechanical ventilation ; NA ; not available ; PGF ; primary graft failure ; VA ; venoarterial ; VV ; venovenous ; V-VA ; veno-venoarterial
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：102
• 期：5
• 页码：1680-1686
• 全文大小：508 K

文摘

Extracorporeal life support (ECLS) as a bridge to lung retransplantation has been reported only anecdotally. Thus, we analyzed combined data from our center with pooled data from published studies to identify selection criteria for this advanced therapy.

Methods

Four patients at our center were bridged on ECLS to lung retransplantation. Patient data were retrospectively retrieved from electronic records. The MEDLINE database was searched using the PubMed engine and yielded 13 relevant studies that included a minimum of 3 patients bridged to lung retransplantation, and four studies described detailed data on 17 patients. Patient data from our center (n = 4) were pooled with data from the MEDLINE database (n = 17) and analyzed.

Results

Of 21 patients, 3 (14%) died on ECLS awaiting retransplantation, and 18 (86%) underwent retransplantation after a median of 37 months (range, 0 to 168 months) after primary transplantation. Type of ECLS was extracorporeal carbon dioxide removal (ECCO2R) in 4, venovenous extracorporeal membrane oxygenation (ECMO) in 7, venoarterial ECMO in 5, or was not mentioned in 2. The 90-day postoperative mortality was 28%. Overall 1-year survival was 48%. Patients bridged to retransplantation with ECCO2R/venovenous ECMO (p = 0.05) or on awake ECMO (p = 0.06) showed strong trends toward better survival in univariate analysis. Univariate and multivariate analysis identified a longer intertransplant interval as a statistically significant favorable prognostic factor. In a selected subgroup of patients (awake ECCO2R/venovenous ECMO support and intertransplant interval >2 years), 1-year survival reached 67%.

Conclusions

Despite limited overall 1-year survival for patients bridged with ECLS to lung retransplantation, careful patient selection may yield an acceptable 1-year survival of 67%.