Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction after Lung Transplantation

Abstract

Purpose Primary graft dysfunction (PGD) is the leading course of early death after lung transplantation. Extracorporeal membrane oxygenation (ECMO) was used as the last resort for PGD. The aim of this study is to explore the outcome and predictor for in-house mortality in post-lung transplant patients who required ECMO for PGD. Methods Between January 2006 and December 2015, 1049 cases of lung transplantation were performed at our center. Ninety-six patients (9.15 %) required ECMO support after lung transplantation. And 52 patients (4.96 %) required ECMO support for PGD. We retrospectively collected patient demographics and survival outcome of these patients. Results The mean age was 61.9 years ± 14.9 years. The mean lung allocation score was 49.5 ± 18.3. Seven patients (13.5 %) required veno-arterial ECMO due to concomitant hemodynamical instability. The patients were on ECMO for 5.00 ± 10.6 days. Forty-four patients (84.6 %) were successfully decannulated. There were 23 in-house mortalities. The 90-day, 1-year and 5-year survival of patients who required ECMO after lung transplantation were 67.3 %, 50.0 %, and 31.5 %, respectively. There is no significant difference on survival outcome when compared to the patient group required ECMO post-transplant due to the other causes. Univariate and multivariate analysis indicated that when the patient was placed on ECMO within 48 hours after transplantation, the patient was more likely to prevent in-house mortality regardless of patients’ preoperative conditions or duration of ECMO support. Conclusion Earlier recognition of PGD and initiation of ECMO may be beneficial in this population.