Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients.
BACKGROUND
Survival after cadaveric lung transplantation (LTx) in respiratory failure recipients who were already dependent on ventilation support prior to transplantation is poor, with a relatively high rate of surgical mortality and morbidity. In this study, we sought to describe the short-term outcomes of bilateral sequential LTx (BSLTx) under extracorporeal membrane oxygenation (ECMO) support in a consecutive series of preoperative respiratory failure patients.


METHODS
Between July 2006 and July 2008, we performed BSLTx under venoarterious (VA) ECMO support in 10 respiratory failure patients with various lung diseases. Prior to transplantation, 6 patients depended on invasive mechanical ventilation support and the others (40%) needed noninvasive positive pressure ventilation to maintain adequate gas exchange. Their mean age was 40.9 years and the mean observation period was 16.4 months.


RESULTS
Except for 1 ECMO circuit that had been set up in the intensive care unit for pulmonary crisis 5 days prior to transplantation, most ECMO (90%) circuits were set up in the operating theater prior to pneumonectomy of native lung during transplantation. Patients were successfully weaned off ECMO circuits immediately after transplantation in 8 cases, and within 1 day (1/10 patients) and after 9 days (1/10 patients) due to severe reperfusion lung edema following transplantation. The mean duration of ECMO support in those successfully weaned off in the operating theater (n = 8) was 7.8 hours. The average duration of intensive care unit stay (n = 10) was 43.1 days (range, 35 to 162 days) and hospital stay (n = 10) was 70 days (range, 20 to 86 days). Although 4 patients (40%) had different degrees of complicated postoperative courses unrelated to ECMO, all patients were discharged home postoperatively. The mean forced vital capacity and the forced expiratory volume in 1 second both increased significantly postoperatively. The cumulative survival rates at 3 months and at 12 months post-transplantation were 100% and 90%.


CONCLUSIONS
Although BSLTx in this critical population has varied surgical complications and prolonged length of postoperative ICU and hospital stays, all the patients observed in this study could tolerate the transplant procedures under VA ECMO support with promising pulmonary function and satisfactory short-term outcome.
Hsu
Hsao-Hsun
HH
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No, 7, Chung-Shan South Road, Taipei City, 100, Taiwan. ntuhsu@gmail.com
Chen
Jin-Shing
JS
Ko
Wen-Je
WJ
Huang
Shu-Chien
SC
Kuo
Shuenn-Wen
SW
Huang
Pei-Ming
PM
Chi
Nai-Hsin
NH
Chang
Chin-Chih
CC
Chen
Robert J
RJ
Lee
Yung-Chie
YC
D000328:Adult; D002102:Cadaver; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D016040:Lung Transplantation; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D016896:Treatment Outcome