Beneficial effects of extracorporeal membrane oxygenation over cardiopulmonary bypass in living-donor lobar lung transplantation
Background: Extracorporeal membrane oxygenation (ECMO) has been frequently used instead of cardiopulmonary bypass (CPB) as extracorporeal circulatory support during cadaveric lung transplantation. This study compared the outcomes of intraoperative CPB or ECMO in living-donor lobar lung transplantation (LDLLT). Methods: CPB and ECMO were performed in 23 and 53 patients, respectively, who underwent initial bilateral LDLLT in our institution from 2008 to 2019. We retrospectively compared the short- and long-term outcomes between the 2 groups. Results: Patient background, graft size-matching data, operation time, extracorporeal circulation time, and bleeding amount were not significantly different in the 2 groups. However, the CPB group required more transfusion than the ECMO group (6,860 vs 3,840 ml, respectively; p = 0.002). The rate of increase in body weight through LDLLT was 7.4% and 4.9% in CPB and ECMO groups, respectively (p = 0.040), and primary graft dysfunction scores were significantly worse in the CPB group. Postoperative ECMO support was required in 4 cases, and hospital death occurred in 1 patient exclusively in the CPB group. Chronic lung allograft dysfunction (CLAD) was diagnosed in 43.5% and 17.0% of patients in the CPB and ECMO groups, respectively (p = 0.021), and the 5-year CLAD-free survival was 55.8% and 72.7% of patients, respectively (p = 0.013). Conclusions: Intraoperative ECMO reduced primary graft dysfunction, possibly due to the lower requirement for intraoperative transfusion and less intraoperative weight gain causing systemic edema. The beneficial effect of ECMO in the early phase may result in less CLAD development in the long-term follow-up after LDLLT.
