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Extracorporeal membrane oxygenation following lung transplantation: indications and survival.

Publication ,  Journal Article
Mulvihill, MS; Yerokun, BA; Davis, RP; Ranney, DN; Daneshmand, MA; Hartwig, MG
Published in: J Heart Lung Transplant
July 1, 2017

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is employed to rescue patients with early graft dysfunction after lung transplantation (LTx). Rates of post-LTx ECMO and subsequent outcomes have been limited to single-center reports. METHODS: UNOS registry was queried for LTx recipients from March 2015 to March 2016; 2,001 recipients were identified and stratified by need for post-LTx ECMO. Logistic regression was used to determine variables associated with post-LTx ECMO. Cox proportional hazards modeling identified factors associated with survival. Kaplan-Meier analysis with log-rank testing was employed for survival analysis. RESULTS: Of 2,001 recipients identified, 107 required post-LTx ECMO (5.1%). Recipients requiring ECMO were younger (56 vs 60 years, p = 0.007) and had higher body mass index (27.2 vs 25.8, p = 0.012). Recipients requiring post-LTx ECMO were more likely to have required mechanical ventilation before transplant (9.3% vs 4.9%, p = 0.049) and were more likely to have required pre-transplant ECMO (15% vs 3.7%, p < 0.001). On multivariable analysis, pre-transplant ECMO and increasing ischemic time were associated with post-LTx ECMO. Six-month survival for recipients requiring ECMO was 62.2%. On multivariable analysis, need for post-transplant dialysis was associated with mortality. Six-month survival for recipients requiring ECMO with and without dialysis was 25.8% and 86.7% (p < 0.001). CONCLUSIONS: In a nationally representative database, ischemic time and pre-transplant ECMO and/or ventilator requirement were associated with need for post-LTx ECMO. Need for post-transplant dialysis was associated with mortality in patients requiring post-LTx ECMO. These data may permit improved prediction of graft dysfunction. Strategies to minimize renal toxicity in the perioperative phase may lead to improved early survival post-LTx.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

July 1, 2017

Location

United States

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Mulvihill, M. S., Yerokun, B. A., Davis, R. P., Ranney, D. N., Daneshmand, M. A., & Hartwig, M. G. (2017). Extracorporeal membrane oxygenation following lung transplantation: indications and survival. J Heart Lung Transplant. https://doi.org/10.1016/j.healun.2017.06.014
Mulvihill, Michael S., Babatunde A. Yerokun, Robert Patrick Davis, David N. Ranney, Mani A. Daneshmand, and Matthew G. Hartwig. “Extracorporeal membrane oxygenation following lung transplantation: indications and survival.J Heart Lung Transplant, July 1, 2017. https://doi.org/10.1016/j.healun.2017.06.014.
Mulvihill MS, Yerokun BA, Davis RP, Ranney DN, Daneshmand MA, Hartwig MG. Extracorporeal membrane oxygenation following lung transplantation: indications and survival. J Heart Lung Transplant. 2017 Jul 1;
Mulvihill, Michael S., et al. “Extracorporeal membrane oxygenation following lung transplantation: indications and survival.J Heart Lung Transplant, July 2017. Pubmed, doi:10.1016/j.healun.2017.06.014.
Mulvihill MS, Yerokun BA, Davis RP, Ranney DN, Daneshmand MA, Hartwig MG. Extracorporeal membrane oxygenation following lung transplantation: indications and survival. J Heart Lung Transplant. 2017 Jul 1;
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

July 1, 2017

Location

United States

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology