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Objective To evaluate the effect of body mass index (BMI) on early prognosis of the recipients after lung transplantation. Methods Clinical data of 307 lung transplant recipients were retrospectively analyzed. According to preoperative BMI, all recipients were divided into the low (BMI <18.5 kg/m2, n=114), normal (18.5 kg/m2≤BMI <24 kg/m2, n=145) and high (BMI≥24.0 kg/m2, n=48) BMI groups, respectively. Baseline data including age, sex, blood type, BMI, preoperative complications, preoperative pulmonary hypertension, and intraoperative use of extracorporeal membrane oxygenation (ECMO) of all recipients were compared among three groups. The survival rate of all recipients was estimated by Kaplan-Meier curve and the survival curve was delineated. The differences of survival rate were analyzed by log-rank test. The 30-, 90- and 180-d mortality risk of all recipients after lung transplantation in different BMI groups was compared by multivariate Cox regression analysis. Results There were significant differences in age and sex of recipients among three groups (both P<0.05). There was a significant difference regarding the 180-d survival rate after lung transplantation among different BMI groups (P<0.05). Multivariate Cox regression analysis showed that the 90-d mortality risk after lung transplantation in the high BMI group was 2.295 times higher than that in the normal BMI group [hazard ratio (HR) 2.295, 95% confidence interval (CI) 1.064-4.947, P=0.034]. In the high BMI group, the 180-d mortality risk after lung transplantation was 2.783 times higher compared with that in the normal BMI group (HR 2.783, 95%CI 1.333-5.810, P=0.006), and the 180-d mortality risk in the low BMI group was 2.181 times higher than that in the normal BMI group (HR 2.181, 95%CI 1.124-4.232, P=0.021). Conclusions Compared with the recipients with normal BMI, their counterparts with high and low preoperative BMI have higher mortality risk early after lung transplantation. Adjusting preoperative BMI to normal range contributes to improving early prognosis of lung transplant recipients.
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As the final resolution for end-stage lung disease, lung transplantation can not only significantly prolong the survival, but also remarkably improve the quality of life of recipients. In recent decades, with the advancement of surgical techniques, immunosuppressants and post-transplantation management, the quantity of lung transplantation has been surged around the globe. However, the shortage of donor lung has severely restricted the development of lung transplantation. It is necessary to develop innovative approaches to expand the donor pool. The number of donors and effective preservation and functional maintenance of potential donor lungs play a key role in expanding the donor pool. The quality of donor lung is a critical precondition to ensure the long-term survival of lung transplant recipients. Preservation and functional maintenance of donor lung are of significance for guaranteeing the quality of lung allograft. In this article, research progresses on the management and maintenance of donor lung before procurement, the procurement of donor lung and the preservation and functional maintenance of lung allograft were reviewed, aiming to provide reference for the development of lung transplantation in clinical practice.
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Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P < 0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P > 0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged < 18, 18-33, 34-49 and ≥50 years (all P > 0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded.
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Objective:To explore the effect of acute kidney injury(AKI)on near-term survival after lung transplantation(LT)in patients with idiopathic pulmonary fibrosis(IPF).Methods:Through consulting electronic medical records, anesthetic modes and Chinese Lung Transplant Registration System, clinical data are retrospectively reviewed for 275 IPF patients undergoing LT at Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2017 to April 2021.According to the diagnostic criteria of Kidney Disease: Improving Global Outcomes(KDIGO), they are divided into two groups of AKI(169 cases)and non-AKI(106 cases).Perioperative findings of two groups are recorded.Then univariate and multivariate Cox regression models are employed for determining whether or not inter-group differences existed in survival rates post-LT.Also AKI is staged according to the KDIGO.And the effect of stage 1/2/3 AKI on near-term postoperative prognosis is examined.Results:The differences are significantly different in recipient gender, creatinine, 6-minute walking test, forced vital capacity(FVC), lung allocation score, oxygenation index, N-terminal pro-brain natriuretic peptide(NT-Pro BNP), preoperative hormone use and volume of crystal infusion( P<0.05).After multivariate Cox regression correcting for covariates, no statistical significance exists in effect of AKI stage 1 on near-term postoperative survival rate( P<0.05).AKI stage 2/3 still has statistical significance in risk of mortality at Day 30/90/180/365 post-operation( P>0.05). Conclusions:As a common complication post-LT, AKI significantly affects near-term postoperative prognosis of transplant IPF patients.Stage 2/3 AKI impacts near-term postoperative survival while stage 1 AKI is not associated with higher mortality.
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Objective:To investigate the risk factors of early death after lung transplantation in patients with idiopathic pulmonary fibrosis (IPF) complicated with pulmonary arterial hypertension (PAH).Methods:A retrospective cohort study was conducted. The clinical data of 134 patients with IPF and PAH who underwent lung transplantation at Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2020 were collected. The donor's gender, age, duration of mechanical ventilation, and cold ischemia time, the recipient's gender, age, body mass index (BMI), smoking, history of hypertension and diabetes, preoperative usage of hormones, mean pulmonary arterial pressure (mPAP), cardiac echocardiography and cardiac function, serum creatinine (SCr), N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as surgical type, extracorporeal membrane oxygenation (ECMO) treatment, duration of operation, and plasma and red blood cell infusion ratio were collected. The cumulative survival rates of patients at 30, 60, and 180 days after lung transplantation were calculated by Kaplan-Meier method. The univariate and multivariate Cox proportional hazards regression models were used to analyze the effects of donor, recipient, and surgical factors on early survival in donors after lung transplantation.Results:The majority of donors were male (80.6%). There was 63.4% of the donors older than 35 years old, 80.6% of the donors had mechanical ventilation duration less than 10 days, and the median cold ischemia time was 465.00 (369.25, 556.25) minutes. The recipients were mainly males (83.6%). Most of the patients were younger than 65 years old (70.9%). Most of them had no hypertension (75.4%) or diabetes (67.9%). The median mPAP of recipients was 36 (30, 43) mmHg (1 mmHg≈0.133 kPa). There were 73 patients with single lung transplantation (54.5%), and 61 with double lung transplantation (45.5%). The survival rates of 134 IPF patients with PAH at 30, 60, 180 days after lung transplantation were 81.3%, 76.9%, and 67.4%, respectively. Univariate Cox proportional risk regression analysis showed that recipient preoperative use of hormone [hazard ratio ( HR) = 2.079, 95% confidence interval (95% CI) was 1.048-4.128], mPAP ≥ 35 mmHg ( HR = 2.136, 95% CI was 1.129-4.044), NT-proBNP ≥ 300 ng/L ( HR = 2.411, 95% CI was 1.323-4.392), New York Heart Association (NYHA) cardiac function classification Ⅲ-Ⅳ ( HR = 3.021, 95% CI was 1.652-5.523) were the risk factors of early postoperative death in patients with IPF complicated with PAH (all P < 0.05). In the multivariable Cox proportional risk regression analysis, recipient preoperative hormone usage (model 1: HR = 2.072, 95% CI was 1.044-4.114, P = 0.037; model 2: HR = 2.098, 95% CI was 1.057-4.165, P = 0.034), NT-proBNP ≥ 300 ng/L ( HR = 2.246, 95% CI was 1.225-4.116, P = 0.009) and NYHA cardiac function classification Ⅲ-Ⅳ ( HR = 2.771, 95% CI was 1.495-5.134, P = 0.001) were independent risk factors of early postoperative death in patients with IPF. Conclusions:Preoperative hormone usage, NT-proBNP ≥ 300 ng/L, NYHA cardiac function classification Ⅲ-Ⅳ are independent risk factors for early death in patients with IPF and PAH after lung transplantation. For these patients, attention should be paid to optimize their functional status before operation. Preoperative reduction of receptor hormone usage and improvement of cardiac function can improve the early survival rate of such patients after lung transplantation.
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The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation (LT) waiting list. A steady increase in the threshold at which age is taken into consideration for LT has been observed. This retrospective cohort study recruited 166 lung transplant recipients aged ≽ 65 years between January 2016 and October 2020 in the largest LT center in China. In the cohort, subgroups of patients aged 65-70 years (111 recipients, group 65-70) and ≽ 70 years (55 recipients, group ≽ 70) were included. Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years. A significantly higher percentage of coronary artery stenosis was observed in the group ≽ 70 (30.9% vs. 14.4% in group 65-70, P = 0.014). ECMO bridging to LT was performed in 5.4% (group 65-70) and 7.3% (group ≽ 70) of patients. Kaplan-Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality. After adjusting for potential confounders, cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality (HR 6.37, P = 0.0060). Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.
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Aged , Humans , East Asian People , Heart Diseases/etiology , Lung Transplantation/adverse effects , Retrospective StudiesABSTRACT
Objective:To compare the effect of extracorporeal membrane oxygenation(ECMO)on pulmonary transplantation(LTx)in patients with idiopathic pulmonary fibrosis(IPF)complicated with pulmonary hypertension(PH).Methods:From January 2017 to December 2020, clinical data were retrospectively reviewed for 112 IPF patients complicated with PH undergoing LTx assisted by venous ECMO(VV-ECMO group, n=68)or venous arterial ECMO(VA-ECMO group, n=44). Gender, age, mechanical ventilation time, oxygenation index, cold ischemic time, preoperative gender, age, smoking history, PO 2, PCO 2, PH degree, NYHA cardiac function grade, right cardiac function, ejection fraction(EF)and complications(hypertension & diabetes)of two groups were compared. Intraoperative approach, operative duration, ECMO transfer time, blood loss, blood transfusion, urine volume, postoperative blood transfusion, mechanical ventilation time, ICU stay time, re-thoracotomy, pulmonary infection, primary graft dysfunction(PGD)and renal insufficiency were recorded. And the effects of two different diversion modes on early postoperative complications and short-term outcomes of LTx were further analyzed by multiple factors. Cox proportional risk model was employed for comparing VV-ECMO and VA-ECMO flow patterns with factors related to recipient survival after transplantation. Results:The preoperative PO 2 of 58.3(51.3, 72.0)mmHg was significantly lower in VV-ECMO bypass group than that of 73.2(63.3, 96.8)mmHg in VA-ECMO group and the difference was statistically significant( P<0.006). Compared with VV-ECMO group, 24(54.5%), 15(34.1%)and 22(50.0%)had NYHA class Ⅲ, severe PH and preoperative right heart enlargement in VA-ECMO group respectively and the differences were statistically significant compared with 17(25.0%), 6(8.8%)and 16(23.5%)in VV-ECMO group( P<0.05 for all). No significant inter-group differences existed in postoperative PGD, postoperative mechanical ventilation time(≥3 d), pulmonary infection, postoperative thoracotomy ratio, postoperative renal insufficiency, ICU stay, hospital stay and other aspects( P>0.05). And 6-month postoperative survival rates of VV-ECMO and VA-ECMO groups were 80.9% and 61.4%, respectively and no significant inter-group difference existed in short-term survival rate(6 months)after adjustment by multivariate Cox regression model( P>0.05). Multivariate statistics indicated that the risk of delayed postoperative withdrawal was 14.452-fold higher in VV-ECMO group than in VA-ECMO group and the inter-group difference was statistically significant(95% CI: 2.448-85.323, P=0.03). Conclusions:No differences exist in postoperative complications or short-term survival rate between IPF recipients with mild PH on VV-ECMO mode and IPF recipients with severe PH on VA-ECMO mode. VV-ECMO flow reversal can delay the transplant back-off time.
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Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.
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Objective:To summarize the strategy of using extracorporeal membrane oxygenation (ECMO) support during lung transplantation from 2 coronavirus disease 2019 (COVID-19) with end-stage respiratory failure.Methods:Two COVID-19 with end-stage respiratory failure patients were admitted to Nanjing Medical University Affiliated Wuxi People's Hospital in March 2020. As the homoeostasis and vital signs could not be maintained in balance by conventional treatments, lung transplantations were performed. Here, detail information about combined application of peripheral veno-venous ECMO (VV-ECMO) and central veno-arterial ECMO (CVA-ECMO) during the operation will be discussed.Results:Case 1: 59 years old, 172 cm height, 72 kg weight, who received mechanical ventilation for 22 days, tracheotomy tube for 17 days, and VV-ECMO support for 7 days. Case 2: 72 years old, 178 cm height, 71 kg weight, who received mechanical ventilation for 19 days, tracheotomy tube for 17 days, and VV-ECMO support for 18 days. As both of them have severe COVID-19-associated respiratory failure, and the recovery was determined to be unlikely, lung transplantations were performed. Severe pulmonary arterial hypertension (PAH) and cardiac insufficiency were found during the operation. Based on preoperative VV-ECMO, CVA-ECMO was added. The concomitant use of peripheral VV-ECMO and CVA-ECMO offered satisfied intraoperative oxygenation and cardiopulmonary status, the operations run smoothly, and the CVA-ECMO was successfully removed, no ECMO-related complications occurred.Conclusion:The combined use of VV-ECMO and CVA-ECMO is an optimal strategy in the end-stage ARDS patients with severe PAH and cardiac insufficiency, which can offer benefits on respiratory and cardiac functions simultaneously, and ensure surgery safety.
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Lung transplantation is the only effective approach to treat end-stage lung diseases. Nevertheless, early prognosis of lung transplant recipients is significantly worse than that of other solid organ transplant recipients. Primary graft dysfunction (PGD) is one of the main causes affecting clinical prognosis of the recipients. PGD is an early acute lung injury after lung transplantation, which is the main cause of early death of lung transplant recipients. Risk factors of PGD after lung transplantation consist of donor, recipient and operation, etc. In this article, the risk factors of PGD after lung transplantation were reviewed, aiming to provide reference for clinical practice.
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Lung transplantation is the ultimate treatment for many kinds of end-stage lung diseases. However, the perioperative management of lung transplantation is complicated with high fatality of patients. Extracorporeal membrane oxygenation (ECMO) is an effective method of extracorporeal respiration and circulation support. ECMO plays an important role in the perioperative support treatment of lung transplantation, which breaks the limitation of contraindications and promotes the development of lung transplantation. In this article, the indications, catheter placement strategies and application of ECMO in the perioperative period of lung transplantation were reviewed.
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In recent years, organ donation has developed rapidly in China, whereas the brain death criteria have not been confirmed by relevant legislation. In this article, the current legislation situation of brain death criteria at home and abroad, and the current criteria for determination of death for organ donation after citizen's death in China were introduced. The necessity of legislation of brain death criteria in China was discussed from the perspective of organ donation, and suggestions on the form and content of brain death criteria legislation were proposed based on the actual national conditions, aiming to provide reference for the legislation of brain death criteria.
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Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.
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As one of the four major types of organ transplantation, lung transplantation has been developed rapidly in recent years. With the establishment of Quality Management and Control Center for Lung Transplantation of National Health Commission, the formulation of Technical Management Specifications for Lung Transplantation and Standard Procedures and Technical Specifications for Lung Transplantation and the implementation of a series of measures, the quality and quantity of lung transplantation have been steadily increased in China. It will provide a guarantee for further promoting the development of lung transplantation in China by the establishment and improvement of scientific quality control parameters for clinical application of lung transplantation technology, the formulation of standard procedures and technical specifications for lung transplantation, strengthening the management of standardized training bases for lung transplantation, building up a multidisciplinary lung transplantation team and constructing a complete lung transplantation database.
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Objective:To explore the effects of secondary pulmonary hypertension(SPH)on postoperative outcomes of lung transplant recipients.Methods:The hospitalization data of 309 patients undergoing lung transplant were retrospectively analyzed. They were divided into normal(mPAP <25 mmHg, 56 cases), low-pressure(mPAP: 25 mmHg≤mPAP<40 mmHg, 155 cases)and high pressure(mPAP ≥40 mmHg, 98 cases)groups.Three groups were compared with regards to general profiles, intraoperative status, postoperative outcomes and survival rates. The postoperative patient survival was plotted by Kaplan-Meier curve and log-rank test performed. Multivariate Cox regression analysis was performed to explore the influencing factors of postoperative survival.Results:The distribution of chronic lung disease(CLD)was statistically different among 3 groups( χ2=30.837, P=0.001). Patients with different levels of pulmonary artery pressure had different decisions supported intraoperatively by extracorporeal membrane oxygenation(ECMO)( χ2=28.205, P<0.001). The 2-year survival rates of normal, low-pressure and high-pressure groups were 58.9 %, 63.9 % and 69.4 % respectively and there were no statistically significant differences( P=0.513). Multivariate Cox regression analysis indicated that preoperative cardiac function was an independent risk factor for postoperative survival. The postoperative risk of mortality was 1.796 (95 %CI: 1.078~2.991)folds higher in patients with cardiac function grade Ⅲ/Ⅳ than those with grade Ⅰ/Ⅱ( P=0.025). Conclusions:Preoperative classification of cardiac function should be emphasized in SPH patients. And surgery during early decompensated stage of cardiac function may confer a better survival.
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Objective:To explore the effect of extracorporeal membrane oxygenation(ECMO)upon supporting during bilateral lung transplantation(BLTx)for different primary diseases.Methods:The clinical data were retrospectively analyzed for 139 cases of BLTx. They were divided into non-ECMO and ECMO groups. The perieoperative data of two groups were compared.Results:BLTx was successfully performed in all patients. As compared with non-ECMO group, operative duration, mechanical ventilation time and ICU hospitalization time were significantly prolonged in ECMO group ( P<0.05). The proportion of patients with different primary diseases was statistically significant different between two groups( P<0.01). ECMO was employed intraoperatively in all IPAH patients. ECMO proportion was higher in idiopathic pulmonary fibrosis(IPF)patients but lower in chronic obstructive pulmonary disease(COPD)counterparts( P<0.05). In terms of cardiac function indices, patients with a moderate/severe elevation of pulmonary artery pressure had a higher proportion of ECMO application( P<0.001). Moreover, the application of ECMO increased with the severity of tricuspid regurgitation and pulmonary vascular resistance(PVR)( P<0.05). Conclusions:It is both safe and feasible to apply ECMO during BLTx. ECMO support should be given a high priority during BLTx for patients with primary diseases such as IPAH, IPF, severe preoperative PAP, tricuspid regurgitation and PVR. On the other hand, ECMO is sufficient as an alternative choice for COPD patients.
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Objective:To explore the safety and nosocomial infection control measures of COVID-19 patients of end-stage respiratory failure after lung transplantation.Methods:Lung transplantation was performed for a COVID-19 patient with end-stage respiratory failure after a negative conversion of 2019-nCoV nucleic acid. Before operation, all medical staff received simulated training on nosocomial infection. The procedures were performed in an operation room with a negative pressure environment. The three-grade preventive strategy was implemented and wearing positive pressure protective mask of electric air supply required. During operation, the patient was managed according to the in-hospital protection process. The environment and medical instruments were disinfected after operation.Results:The operation was completed successfully. The 2019-nCoV nucleic acid test was negative for many times after operation. Participants were placed in medical isolation for 14 days after surgery. During the period, nucleic acid test was negative twice.Conclusions:As an exploratory treatment, lung transplantation is a safe option for end-stage respiratory failure in COVID-19 in operation room with a negative pressure environment and implementations of three-grade preventive strategy.
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Objective:To explore the indications of lung transplantation for pulmonary interstitial fibrosis after COVID-19 and the precautionary measures of medical staff during operation.Methods:Lung transplantation was performed for three cases of COVID-19 from February 15, 2020 to March 1, 2020. The course of disease, mechanical ventilation time, extra-corporeal membrane oxygenation (ECMO) support time, surgical procedures and precautionary measures of medical staff during operation were analyzed.Results:The course of disease were 40, 7, 39 days, the mechanical ventilation time 26, 22, 27 days and ECMO support time 16, 7, 14 days. The postoperative pathological results of three cases indicated pulmonary interstitial fibrosis. One case died on the operative day and two survivors stayed currently in rehabilitation. Thirty-nine medical staff had no symptoms of COVID-19 after 14 days of isolation. The detection of 2019-nCoV nucleic acid was negative for both nasal and pharyngeal swabs.Conclusions:Patients with pulmonary interstitial fibrosis after COVID-19 show no improvement after 1 month of active medical treatment. And the 1-month risk of mortality was over 50% and nucleic acid of 2019-nCoV turned negative. Lung transplantation might be considered. The triple precautionary levels of medical staff during operation prevented the transmission of 2019-nCoV.
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Objective To evaluate the intraoperative condition and prognosis of extracorporeal memberane oxygenation (ECMO) in patients with idiopathic pulmonary fibrosis (IPF) undergoing single lung transplantation.Methods Fifty-five patients (49 males and 6 females,aged 18-75 years,ASA physical status Ⅲ or Ⅳ) undergoing single lung transplantation were divided into ECMO group (E group,n =41) and control group (C group,n =15).Lung ischemia time,operative time,intraoperative crystal fluid volume,intraoperative colloids fluid volume,total fluid volume,albumin volume,bleeding volume,blood transfusion volume and urine volume were recorded.ECMO time,extubation time,the length of ICU stay and postoperative hospital stay were assessed.Results There was no significant difference in lung ischemia time,operative time,intraoperative crystal fluid volume,intraoperative colloids fluid volume,total fluid volume,albumin volume,bleeding volume,volume of blood transfusion,urine volume,ECMO time,extubation time,the length of ICU stay,postoperative hospital stay and mortality rate during hospitalization between the two groups.Blood plasma volume was significantly more in E group (9.3 ± 4.5 mL/kg) than that in C group (5.4 ± 4.2 mL/kg;P＜0.01).ECMO time was positively related to extubation time,the length of ICU stay and mortality rate during hospitalization (P＜0.01).Conclusion ECMO does not affect intraoperative condition and prognosis of patients.According to ECMO time we can judge the prognosis of patients.
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Objective To explore the key points of anaesthetic management of bilateral lung transplantation treating severe idiopathic pulmonary arterial hypertension.Methods Clinical data of 20 cases with severe IPAH treated by bilateral lung transplantation were analyzed retrospectively, 2 males and 18 females, ASA physical status Ⅲ or Ⅳ.The hemodynamic changes were observed at various points (30 min after double lung ventilation, 15 min after ECMO, during one-lung ventilation, 30 min after pulmonary artery block, at the opening of pulmonary artery and at the end of surgery) and pre-and post-operative changes of cardiovascular morphology were analyzed with heart ultrasound.Results Compared with 30 min after double lung ventilation, PaO2 and SVV were significantly increased and PAP, PAWP and PaCO2 were decreased 15 min after extracorporeal membrance oxygenation (ECMO) (P<0.05).PAP and PAWP were significant higher and SVV was lower 30 min after pulmonary artery block than 15 min after ECMO (P<0.05).Opening of pulmonary artery had significantly increased SVV and reduced PAP and PAWP compared with pulmonary artery block (P<0.05).ECMO was removed in 4 cases at end of the surgery.The remaining 16 cases assisted by ECMO were transferred to ICU, 3 cases underwent thoracotomy for exploration and hemostasis 1 day after the operation while 13 cases suffered from different degrees of left heart dysfunction postoperatively, 4 of which had acute heart failure.Of the 4 cases, 2 were treated by right femoral vein-right femoral artery bypass (V-A ECMO bypass) and 2 underwent right femoral vein-right internal jugular vein bypass (V-V ECMO bypass).Moreover, 3 cases performed tracheotomy 5 days, 6 days and 13 days day after the operation, respectively.All the patients were cured and discharged.Their cardiovascular morphology was improved.Conclusion The key successful factors of IPAH treated by bilateral lung transplantation are to improving perioperative heart function, keeping stable hemodynamics during induction of anesthesia and the operation and using ECMO properly and postoperative support.