title: Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation.
abstract: 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.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: James Z
authors.initials: JZ
authors.lastname: Appel
authors.forename: Edward
authors.initials: E
authors.lastname: Cantu
authors.forename: Sinan
authors.initials: S
authors.lastname: Simsir
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.forename: Chong-Chao
authors.initials: CC
authors.lastname: Hsieh
authors.forename: Richard
authors.initials: R
authors.lastname: Walczak
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
mesh_terms: 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