title: Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation.
abstract: BACKGROUND
  Previous reports demonstrate that 1-year survival is severely compromised in patients with severe primary graft dysfunction (PGD) after lung transplantation. We examined if advances in extracorporeal membrane oxygenation (ECMO) support, including polymethylpentene oxygenators and reliance on venovenous (VV) ECMO have improved outcomes in patients with severe PGD after lung transplantation.
  
  
  METHODS
  The analysis included data prospectively collected on all single-lung or double-lung transplants between November 2001 and December 2009. Heart-lung transplants were excluded. Comparisons were made between recipients who did and did not require ECMO for PGD after transplant.
  
  
  RESULTS
  Since November 2001, when VV ECMO became the routine treatment for severe PGD after transplant at our center, 28 of 498 patients (6%) have required VV ECMO support. Successful weaning occurred in 27 of 28 (96%). Support was withdrawn for 1 patient with irreversible neurologic injury. Survival was substantially better than in previous reports: 30 days, 82%; 1 year, 64%; and 5 years, 49%. Freedom from bronchiolitis obliterans syndrome was 88% in the ECMO survivors at 3 years, but maximum allograft function was considerably worse than in transplant recipients not requiring ECMO (peak forced expiratory volume in 1 second: 58% in ECMO vs 83% in non-ECMO, p=0.001).
  
  
  CONCLUSIONS
  Advances in ECMO technology, particularly VV ECMO, have greatly improved the ability to support patients with severe PGD after lung transplantation. VV ECMO is an important tool in the armamentarium of any lung transplant program to optimize patient outcomes; however, strategies to improve lung allograft function in patients experiencing severe PGD are still needed.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: Richard
authors.initials: R
authors.lastname: Walczak
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
mesh_terms: D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011182:Postoperative Care; D055031:Primary Graft Dysfunction / Q000401:mortality*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents