title: Survival benefit of cardiopulmonary bypass support in bilateral lung transplantation for emphysema patients.
abstract: BACKGROUND
  This study is designed to examine a possible association of cardiopulmonary bypass (CPB) support and outcome of lung transplantation in a well-balanced group of emphysema patients.
  
  
  METHODS
  We performed a retrospective analysis of 62 consecutive primary bilateral lung transplantations for emphysema. Risk factors for their possible association with patient survival were analyzed by multivariate logistic regression.
  
  
  RESULTS
  The use of CPB support was associated with improved survival (odds ratio=0.25; P=0.038). The actuarial survival at 1 year was 97% for patients treated with CPB and 77% for patients treated without CPB support. In 28 patients (45%), 2 human leukocyte antigen (HLA)-DR mismatches between donor and recipient occurred, whereas 34 patients had 0 or 1 HLA-DR mismatches. The use of CPB support in the group with two HLA-DR mismatches was associated with improved survival (odds ratio=0.06; P=0.020). This association was not present in the group with 0 or 1 HLA-DR mismatches.
  
  
  CONCLUSIONS
  These results demonstrate a significant survival benefit of CPB support during bilateral lung transplantation in emphysema patients. The difference in survival benefit of CPB support between the patients with 0 or 1 HLA-DR mismatches and the patients with 2 HLA-DR mismatches indicates that the immunosuppressive effect of CPB support might be responsible for this survival benefit. The underlying immunological mechanism might be important in the future treatment of organ transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Groningen, 9700 RB Groningen, The Netherlands. W.J.de.Boer@ thorax.azg.nl
authors.forename: Willem J
authors.initials: WJ
authors.lastname: de Boer
authors.forename: Bouke G
authors.initials: BG
authors.lastname: Hepkema
authors.forename: Bert G
authors.initials: BG
authors.lastname: Loef
authors.forename: Wim
authors.initials: W
authors.lastname: van der Bij
authors.forename: Erik A M
authors.initials: EA
authors.lastname: Verschuuren
authors.forename: Hans J
authors.initials: HJ
authors.lastname: de Vries
authors.forename: Simon P M
authors.initials: SP
authors.lastname: Lems
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
mesh_terms: D002315:Cardiopulmonary Bypass; D018572:Disease-Free Survival; D004646:Emphysema / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology*; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists