title: Outcome of extracorporeal membrane oxygenation for early primary graft failure after pediatric heart transplantation.
abstract: OBJECTIVE
  We sought to analyze the indications and outcome of extracorporeal membrane oxygenation (ECMO) for early primary graft failure and determine its impact on long-term graft function and rejection risk.
  
  
  BACKGROUND
  Early post-operative graft failure requiring ECMO can complicate heart transplantation.
  
  
  METHODS
  A retrospective review of all children requiring ECMO in the early period after transplantation from 1990 to 2007 was undertaken.
  
  
  RESULTS
  Twenty-eight (9%) of 310 children who underwent transplantation for cardiomyopathy (n = 5) or congenital heart disease (n = 23) required ECMO support. The total ischemic time was significantly longer for ECMO-rescued recipients compared with our overall transplantation population (276 +/- 86 min vs. 242 +/- 70 min, p < 0.01). The indication for transplantation, for ECMO support, and the timing of cannulation had no impact on survival. Hyperacute rejection was uncommon. Fifteen children were successfully weaned off ECMO and discharged alive (54%). Mean duration of ECMO was 2.8 days for survivors (median 3 days) compared with 4.8 days for nonsurvivors (median 5 days). There was 100% 3-year survival in the ECMO survivor group, with 13 patients (46%) currently alive at a mean follow-up of 8.1 +/- 3.8 years. The graft function was preserved (shortening fraction 36 +/- 7%), despite an increased number of early rejection episodes (1.7 +/- 1.6 vs. 0.7 +/- 1.3, overall transplant population, p < 0.05) and hemodynamically comprising rejection episodes (1.3 +/- 1.9 vs. 0.7 +/- 1.3, overall transplant population, p < 0.05).
  
  
  CONCLUSIONS
  Overall survival was 54%, with all patients surviving to at least 3 years after undergoing transplantation. None of the children requiring >4 days of ECMO support survived. Despite an increased number of early and hemodynamically compromising rejections, the long-term graft function is similar to our overall transplantation population.
authors.affiliation: Children's Hospital of Denver, Aurora, CO, USA. cecile.tissot@hotmail.com
authors.forename: Cecile
authors.initials: C
authors.lastname: Tissot
authors.forename: Shannon
authors.initials: S
authors.lastname: Buckvold
authors.forename: Christina M
authors.initials: CM
authors.lastname: Phelps
authors.forename: D Dunbar
authors.initials: DD
authors.lastname: Ivy
authors.forename: David N
authors.initials: DN
authors.lastname: Campbell
authors.forename: Max B
authors.initials: MB
authors.lastname: Mitchell
authors.forename: Suzanne Osorio
authors.initials: SO
authors.lastname: da Cruz
authors.forename: Bill A
authors.initials: BA
authors.lastname: Pietra
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D009202:Cardiomyopathies / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055031:Primary Graft Dysfunction / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
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