title: Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation.
abstract: BACKGROUND
  Our management of patients with idiopathic pulmonary arterial hypertension (iPAH) awaiting lung transplantation changed in 2006 with the introduction of extracorporeal life support (ECLS) as an option to bridge these patients to transplantation (BTT).
  
  
  METHODS
  To study the effect of this change on waiting list mortality and post-transplant outcome, 21 consecutive iPAH patients listed for lung transplantation between January 2006 and September 2010 (second cohort) were compared with 23 consecutive iPAH patients listed between January 1997 and December 2005 (first cohort).
  
  
  RESULTS
  Between the first and second cohort, the number of patients admitted to the hospital as BTT increased from 4% (1 of 23) to 48% (10 of 21; p = 0.0009). Six patients were BTT with ECLS in the second cohort, including 4 with the Novalung device (Novalung GmbH, Hechingen, Germany) connected as a pumpless oxygenating right-to-left shunt between the pulmonary artery and left atrium. While on the waiting list, 5 patients (22%) died in the first cohort and none in the second cohort (p = 0.03). Time on the waiting list decreased from 118 ± 85 to 53 ± 40 days between the first and second cohort (p = 0.004). After lung transplantation, the 30-day mortality was 16.7% in the first cohort and 9.5% in the second cohort (p = 0.5). The postoperative intensive care unit stay increased from 17 ± 13 to 36 ± 30 days between the first and second cohort (p = 0.02). The long-term outcome after lung transplantation remained similar between both cohorts.
  
  
  CONCLUSIONS
  Aggressive management with ECLS of iPAH patients awaiting lung transplantation could have a major impact to reduce the waiting list mortality. This may, however, be associated with longer intensive care unit stay after transplant.
authors.affiliation: Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada. marc.deperrot@uhn.on.ca
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.forename: Andrew
authors.initials: A
authors.lastname: Pierre
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.forename: Michael
authors.initials: M
authors.lastname: Hutcheon
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.forename: Lianne
authors.initials: L
authors.lastname: Singer
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000639:trends*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay; D008020:Life Support Care / Q000379:methods*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists