Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation.
The records of 100 lung transplant recipients (13 heart-lungs, 45 double-lungs, and 42 single-lungs) from September 1990 through April 1992 were reviewed to determine the role of cardiopulmonary bypass (CPB) in early graft dysfunction. Fifty-five patients requiring CPB (CPB group) for 186 +/- 54 minutes were compared with the 45 patients without CPB (no-CPB group). All of the heart-lung and en-bloc double-lung transplantations were performed under CPB, with pulmonary vascular lung disease the principal diagnosis, resulting in a significantly younger age population in the CPB group. All other donor- and recipient-related factors matched well in both groups. Of 38 bilateral single-lung transplantations, CPB was used in 18. In double-lung and heart-lung recipients gas exchange of the allografts was evaluated by the arterial/alveolar oxygen tension ratios at nine intervals during the first 72 hours. The mean arterial/alveolar oxygen tension ratio in the CPB group was 0.48 +/- 0.19, significantly lower than in the no-CPB group with 0.60 +/- 0.22 (p = 0.025). All patients had radiographic interpretation and scoring of pulmonary infiltrates from chest roentgenograms taken within 12 hours after reperfusion. The CPB group had more severe pulmonary infiltrates than the no-CPB group (p = 0.034). Prolonged intubation defined as 7 days or longer occurred significantly more often (29/55) in the CPB group than in the no-CPB group (8/45) (p = 0.003). Actuarial graft and patient survival at 1 month was better in the no-CPB group than in the CPB group (42/45 versus 44/55 [p = 0.05] and 43/45 versus 45/55 [p = 0.033], respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Aeba
R
R
Division of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania.
Griffith
B P
BP
Kormos
R L
RL
Armitage
J M
JM
Gasior
T A
TA
Fuhrman
C R
CR
Yousem
S A
SA
Hardesty
R L
RL
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D005260:Female; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000401:mortality / Q000473:pathology; D006801:Humans; D007442:Intubation, Intratracheal; D008168:Lung / Q000473:pathology / Q000503:physiopathology*; D016040:Lung Transplantation / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000502:physiology; D011650:Pulmonary Alveoli / Q000473:pathology; D011659:Pulmonary Gas Exchange; D013902:Radiography, Thoracic; D015996:Survival Rate
D010100:Oxygen