The Effect of the Elective Intra-Operative Use of Mechanical Circulatory Support on the Development of Primary Graft Dysfunction Following Bilateral Lung Transplantation

Abstract

Purpose Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplant. Studies have identified the intraoperative use of cardiopulmonary bypass (CPB) as a risk factor for PGD. There has been an increase in the use of extracorporeal membrane oxygenation (ECMO) for intraoperative support over the last decade. We sought to further evaluate the differential risk of PGD across various extracorporeal life support (ECLS) modalities. Methods Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplant. Studies have identified the intraoperative use of cardiopulmonary bypass (CPB) as a risk factor for PGD. There has been an increase in the use of extracorporeal membrane oxygenation (ECMO) for intraoperative support over the last decade. We sought to further evaluate the differential risk of PGD across various extracorporeal life support (ECLS) modalities. Results A model including age, race, body mass index, diagnosis and pulmonary artery pressure was developed to predict ECLS use. Our analysis included 238 patients who underwent BLT (figure 1). 49 patients who received elective intra-operative ECMO after 2015 were matched with 49 patients who received intraoperative CPB before 2015. There was no difference in the development of severe PGD (p=0.4) or any PGD (p=0.6) between the two groups. Seventy patients who underwent BLT with no ECLS after 2015 were matched with 70 patients who underwent BLT before 2015 with CPB support. There was no difference in the development of severe PGD (p=0.2) or any PGD (p=0.3) between the two groups. Exclusion of patients bridged to transplant with ECMO didn't alter the results. Conclusion In a single center study of BLT recipients, there was no difference in the development of PGD across different ECLS modes. Future analysis will compare the impact of ECMO vs. CPB on biomarkers associated with lung and endothelial injury.