Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation.
BACKGROUND
Primary graft failure remains a significant source of mortality after lung transplantation. Extracorporeal membrane oxygenation (ECMO) provides treatment for affected recipients. We hypothesized that venovenous membrane oxygenation provides a safer alternative than venoarterial support for lung recipients suffering from primary graft failure.


METHODS
We conducted an analysis of 522 patients who underwent lung transplantation from April 1992 to July 2004. Twenty-three (4.5%) patients required membrane oxygenation secondary to primary graft failure unresponsive to conventional treatment. Of these recipients, 15 (65%) were treated with venoarterial, while 8 (35%) underwent venovenous membrane oxygenation.


RESULTS
Median days to initiation and duration of membrane oxygenation did not differ between groups. Eight of 15 patients (53%) from the venoarterial group were successfully weaned from life support, with one surviving greater than 45 days. This lone long-term survivor required retransplantation 4 days after initial transplant. In contrast, all venovenous patients were weaned from support, with 7 of 8 surviving greater than 30 days. The 30-day survival for venovenous recipients (88%) approximates that of all lung recipients at our center (94%, p = 0.42). Noted complications for ECMO patients included renal failure (n = 16), neurologic catastrophes (n = 8), sepsis (n = 5), and hemorrhage (n = 10). The venoarterial recipients suffered 30 of 39 total complications. Most of the complications for venovenous recipients involved renal failure, but by hospital discharge these patients demonstrated a mean creatinine of 0.9 mg/dL.


CONCLUSIONS
For lung recipients with primary graft failure, venovenous membrane oxygenation provides better outcomes, with fewer complications, than venoarterial membrane oxygenation.
Hartwig
Matthew G
MG
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Appel
James Z
JZ
Cantu
Edward
E
Simsir
Sinan
S
Lin
Shu S
SS
Hsieh
Chong-Chao
CC
Walczak
Richard
R
Palmer
Scott M
SM
Davis
R Duane
RD
D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged