title: Modified low-flow ultrafiltration ameliorates hemodynamics and early graft function and reduces blood loss in living-donor lobar lung transplantation.
abstract: BACKGROUND
  This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT).
  
  
  METHODS
  The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed.
  
  
  RESULTS
  There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p < 0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO(2)/FiO(2;) 411 +/- 107 vs 272 +/- 107 mm Hg, p < 0.05) and the alveolar-arterial oxygen difference (a-aDO(2); 158 +/- 84 vs 315 +/- 127 mm Hg, p < 0.05) at 15 minutes after CPB. There were no differences in PaO(2)/FiO(2) and A-aDO(2) between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p < 0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups.
  
  
  CONCLUSIONS
  The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.
authors.affiliation: Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kotani
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.forename: Keiji
authors.initials: K
authors.lastname: Goto
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Fujita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ito
authors.forename: Mahito
authors.initials: M
authors.lastname: Nakakura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawada
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kotani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date