Mechanical Circulatory Support in Lung Transplant Recipients: Early and Long-Term Survival

Abstract

<h3>Purpose</h3> Lung transplantation can be performed off-pump with sequential one-lung ventilation or with mechanical circulatory support (MCS) either by using a cardiopulmonary bypass or veno-venous / veno-arterial extracorporeal membrane oxygenation. Furthermore, MCS might be necessary throughout postoperative course for improving pulmonary function. Here we aimed to investigate early and long-term survival of lung recipients, who are temporarily in need for mechanical circulatory support during lung transplantation and / or after and additionally who did not receive any mechanical circulatory support. <h3>Methods</h3> We performed a retrospective review of patients who underwent lung transplantation at our center between January 2009 and July 2021. We compared 100 days survival as well as five-year survival of lung transplant recipients, who received mechanical circulatory support intra- and postoperatively (group 1, n=14) vs. no mechanical circulatory support (group 2, n=14) or just intraoperatively (group 3, n=69). Survival depicted as Kaplan-Meier-Curves. <h3>Results</h3> Recipients treated with mechanical circulatory support intra- and postoperatively after lung transplantation (n=14), presented with pulmonary artery hypertension (n=5), pulmonary veno-occlusive disease (n=1), idiopathic fibrosis (n=2), Sarcoidosis (n=1) and chronic obstructive pulmonary disease (n=5). 100 days after initial lung transplantation 4 out of 14 patients were alive. Early survival between group 1 and 2 was 38.5% vs. 85.7% (p=0.0073) and as compared to group 3 38.5% vs 90.9% (p<0.0001). Five-year survival was 33.3% in patient group 1 compared to 67.3% in group 3 (p<0.0001) as well as 33.3% vs 64.3% when compared to patient group 2 (p=0.0262). Survival between group 2 and 3 did not differ significantly. <h3>Conclusion</h3> Here we report clearly that patients after lung transplantation who needed intra- and postoperatively mechanical circulatory support have a significantly reduced early as well as long-term survival compared to recipients without any need of mechanical circulatory support or only intraoperatively. Early and long-term survival of lung recipients treated with circulatory support only intraoperatively did not differ when compared to patients without any use of support.