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Ann Thorac Surg 2009;87:854-860. doi:10.1016/j.athoracsur.2008.11.036
© 2009 The Society of Thoracic Surgeons
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Christian A. Bermudez
Prasad S. Adusumilli
Kenneth R. McCurry
Yoshiya Toyoda
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Right arrow Lung - transplantation

Original Articles: General Thoracic

Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Lung Transplantation: Long-Term Survival

Christian A. Bermudez, MD*, Prasad S. Adusumilli, MD, Kenneth R. McCurry, MD, Diana Zaldonis, MPH, BSN, Maria M. Crespo, MD, Joseph M. Pilewski, MD, Yoshiya Toyoda, MD, PhD

Heart, Lung and Esophageal Surgery Institute, Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

Accepted for publication November 17, 2008.

* Address correspondence to Dr Bermudez, UPMC-Presbyterian University Hospital, 200 Lothrop St, Suite C900, Pittsburgh, PA 15213 (Email: bermudezc{at}upmc.edu).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Primary graft dysfunction (PGD) after lung transplantation is a major cause of morbidity and mortality. Venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) allows lung recovery; however, the optimal approach and impact on long-term survival are unknown. We analyzed outcomes after ECMO use for PGD after lung transplantation at a single center over a 15-year period and assessed long-term survival.

Methods: From March 1991 to March 2006, 763 lung or heart-lung transplants were performed at our center. Fifty-eight patients (7.6%) required early (0 to 7 days after transplant) ECMO support for PGD. Venovenous or venoarterial ECMO was implemented (32 and 26 cases) depending on the patient's hemodynamic stability, surgeon's preference, and the era of transplantation. Mean duration of support was 5.5 days (range, 1 to 20). Mean follow-up was 4.5 years.

Results: Thirty-day and 1- and 5-year survivals were 56%, 40%, and 25%, respectively, for the entire group. Thirty-nine patients were weaned from ECMO, 21 venovenous and 18 venoarterial (53.8% and 46.2%), with 1- and 5-year survivals of 59% and 33%, inferior to recipients not requiring ECMO (p = 0.05). Survival at 30 days and at 1 and 5 years was similar for the patients supported with venoarterial or venovenous ECMO (58% versus 55%, p = 0.7; 42% versus 39%, p = 0.8; 29% versus 22%, p = 0.6).

Conclusions: Extracorporeal membrane oxygenation can provide acceptable support for PGD irrespective of the method used. Long-term survival of patients with primary graft dysfunction requiring ECMO (overall and weaned) was inferior to that of patients who did not require ECMO.






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