ABSTRACT
Primary graft dysfunction (PGD) is the leading cause of short- and long-term mortality associated with lung transplants. The association between pre-donation donor blood transfusion and intra operative massive blood transfusion with PGD has been reported. However the impact of pre-transplantation recipient blood transfusion on PGD risk has not been studied. This study aimed to assess the association between PGD and pre-transplant recipient blood transfusion. We conducted a retrospective study of 206 patients who underwent lung transplant at a single institution from January 2018 through July 2022. Data on patient characteristics, pre-transplantation laboratory values, transfusion requirements, and intra- and post-operative outcomes were collected. Results were analyzed using chi-square and t-tests and logistic regression analyses. PGD 2/3 occurred in 30.1% of the cohort (n=62). Thirty-three patients received a blood transfusion within 4 weeks, while 21 received a blood transfusion within 1 week before their lung transplant. Pre-transplant transfusion was strongly associated with higher incidence of PGD 2/3 (48.5% vs 6.9%, P <0.001). There was no significant difference in one year survival between pre-transplant transfused group and non-transfused group (77.7% vs 88.0 %, P =0.478).In univariate analysis, pre and intra-transplant predictors of PGD3 included younger age (p <0.01), pre extracorporeal membrane oxygenation (ECMO) use (p <0.001), higher lung allocation score (p <0.001), COVID related acute respiratory distress syndrome (p <0.01), lower hemoglobin (p <0.01), lower platelets (p =0.003), lower albumin (p <0.001), higher total bilirubin (p <0.01), lower PaO2 (p <0.02), blood transfusion within 4 weeks (p <0.001), longer operative time (p <0.001), intra-transplant blood transfusion (p <0.001), intra transplant VA ECMO use (p <0.001). In multivariate analysis, lower albumin was an independent risk factor of PGD3 (OR 0.25, 95%CI: 0.08-0.76, P <0.015). Pre-transplant blood transfusion could be attributed to a higher rate of PGD. We found no significant difference in one post lung transplant one year survival between pre-transplant blood transfused recipient group and non-transfused group. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Lung transplantation is a potentially lifesaving treatment for critically ill patients with COVID-19-associated acute respiratory distress syndrome (ARDS). Many patients require extracorporeal membrane oxygenation (ECMO) as life-saving support when other traditional treatments fail. However, there is limited information regarding the long-term outcomes of VV-ECMO use as a bridge to lung transplantation in patients with ARDS. This was a retrospective review of an institutional lung transplant database. We included consecutive lung transplant recipients between June 2020 and June 2022. Demographic, clinical, laboratory, treatment data, the outcomes of lung transplantation, and survival were collected and analyzed. Kaplan-Meier and Wilcoxon tests were used to evaluate survival rates. Among the 41 lung transplant recipients for COVID-19-associated ARDS, 25 patients (median age 53 years [IQR, 36-55];11 women [44.0%]) had ECMO bridges and 16 patients (median age 54.5 years [IQR, 52.75 to 63];7 women [43.8%]) did not. For lung transplant recipients with ECMO bridges compared to those without, the median lung allocation scores were 88.1 vs. 74.9 (p<0.001). During transplantation, patients with COVID-19-associated ARDS received transfusions with a median of ten units of packed red blood cells vs. two units in those without ECMO bridges;96.0% vs. 93.8% underwent intraoperative venoarterial ECMO, and the median operative time was 9.5 hrs. vs. 7.8 hrs., respectively. Postoperatively, the rates of primary graft dysfunction grade 3, within 72 hrs., were 44% in the ECMO bridge vs. 0% in those without them. The median duration of intensive care unit stays was 20 days vs. 13 days, and the median post-lung transplant hospitalization duration was 35 days vs. 19.5 days, respectively. After follow-up (median follow-up period: 448 days [IQR, 314-664] in patients with ECMO bridges vs. 417 days [IQR, 389.5-506] in patients without them), one-year survival rates were 78.3% in patients with ECMO bridges and 100.0% in patients without (p=0.06). In this single-center case series of 41 consecutive patients who underwent lung transplantation for COVID-19-associated ARDS, patients on an ECMO bridge showed a more severe cohort. However, there was no significant difference in the overall outcomes between the two groups (p=0.06). [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
In patients with COVID-19-associated acute respiratory distress syndrome (ARDS), decreased pulmonary compliance, increased pulmonary vascular resistance and micro pulmonary thrombosis increase the right heart burden, which can lead to right heart failure. However, the impact of lung transplantation for ARDS on the right heart is unclear. Therefore, we evaluated changes in heart function and structural abnormalities with pre- and postoperative transthoracic echocardiography (TTE). This study was a retrospective review of the institutional lung transplantation database from June 2020 to June 2022. Pre- and postoperative TTE were performed, and postoperative TTE beyond 90 days was recorded. Right ventricular (RV) function and size were evaluated and scored. The Wilcoxon signed-rank test was used to compare pre- and postoperative TTE values. During the period, 42 patients underwent lung transplantation for COVID-19-associated ARDS: 10 were excluded (two single-lung, one lobar, one dual-organ transplant, and six patients with missing postoperative TTE data);and 32 were included in the study. TTE was evaluated at a median of 15 days preoperatively (IQR 9.5-30) and 144.5 days postoperatively (IQR 112-210). Pre- and postoperative TTE showed significant changes in mitral A, lateral E', RV estimated systolic pressure (RVSP), RV function and size (Figure 1 and Table 1). In patients with severe right heart dysfunction due to COVID-19-associated ARDS, RV function and structure normalized within a relatively short period after lung transplantation. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Severe right heart failure (RHF) is a known complication of pulmonary hypertension, which increases mortality before lung transplantation. The safety and feasibility of venovenous (VV)-extracorporeal oxygenation (ECMO) using ProtekDuoTM (CardiacAssist Inc., Pittsburgh, PA) as a bridge to lung transplantation in severe RHF caused have not been well studied. This study aimed to evaluate the safety and feasibility of VV-ECMO using ProtekDuoTM as a bridge to lung transplantation in patients with severe RHF. This study was a prospective review of the institutional lung transplantation database from June 2020 to June 2022. Patients who underwent lung transplantation with VV-ECMO using ProtekDuoTM for COVID-19 associated acute respiratory distress syndrome (ARDS) were prospectively enrolled;and preoperative and postoperative transthoracic echocardiographic (TTE) data were analyzed. RV function and size were evaluated and scored. The Wilcoxon signed-rank test was used to compare pre- and post-operative TTE values. During the study period, 20 patients underwent lung transplantation for COVID-19-associated ARDS with preoperative VV-ECMO using ProtekDuoTM. TTE was assessed at a median of 15 days preoperatively (IQR, 7.75-31) and 155.5 days postoperatively (IQR, 112-210). Pre and post-operative median RVSP was 45.4 mm Hg (IQR, 29.4-49.0) and 30.0 mm Hg (IQR, 28.0-35.0), p=0.02, and the median mitral valve A was 0.70 cm/s (IQR, 0.70-0.80) and 0.55 cm/s (IQR, 0.50-0.70), p=0.03 (Table1). All patients were hemodynamically stable with active rehabilitation and did not require inotropes or inhaled nitric oxide. VV-ECMO with ProtekDuoTM for patients with COVID-19-associated ARDS before lung transplantation can stabilize patients without significant complications and allows active rehabilitation of patients with severe RHF. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Cytomegalovirus (CMV) infection is associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes has been considered a risk factor for mortality, which donor CMV-IgG positive-recipient CMV-IgG negative (D+R-) group is a high risk for CMV infection and mortality. However, the risk factors in this group of patients remain unclear. We evaluated the impact of donor and recipient CMV status on long-term outcomes, as well as the risk factors for CMV infection. This was a prospective review of the institutional lung transplantation database from June 2014 to June 2022. Data on patient characteristics, pre-transplantation laboratory values, postoperative outcomes, and CMV infection were collected. All patients received a prophylactic dose of valganciclovir hydrochloride (900 mg once daily) after lung transplantation. The donor positive-recipient CMV-IgG negative group was defined as the CMV-mismatch group. The results were analyzed using the chi-square test, Mann-Whitney U test, t-test, logistic regression analyses, and receiver operating characteristic curve analysis. During the study period, 257 patients underwent lung transplantation. CMV infection was detected in 69 patients (26.8%):25 of 203 (12.3%) in the non-CMV mismatch group and 29 of 54 (53.7%) in the CMV mismatch group (p<0.001). CMV infection occurred 395 days (IQR;264-452) in the entire cohort. In multivariate logistic analysis, COVID-19-associated acute respiratory distress syndrome etiology, lower albumin level, and CMV mismatch were independent factors for CMV infection (COVID-19-related ARDS, OR=3.03, 95% CI=1.20-7.64, p=0.02;albumin [g/dl], OR=0.34, 95% CI=0.16-0.70, p<0.01;CMV mismatch, OR=6.66, 95% CI=2.79-15.9, p<0.001). Receiver operating characteristic curve analysis showed that an albumin of 4.0 g/dl was the cut-off value (area under the curve=0.64) for the risk of CMV infection. In the CMV mismatch group, hemodialysis use after discharge was associated with CMV infection (OR=9.10, 95% CI=1.02-82.4, p=0.04). In patients with CMV mismatch, hemodialysis use was an independent predictor of CMV infection. Further studies are needed to determine the risks and benefits of extending CMV prophylaxis or aggressive CMV treatment, particularly in high-risk groups. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Introduction: Dual-lumen cannula is used for extracorporeal membrane perfusion (ECMO) to support patients with ARDS due to COVID-19 as a bridge to lung recovery. It tends to be a longer support and there are several factors that can degrade the physical structure of the ECMO cannula and put the cannula at risk for breakage. Case Report: A 63-year-old woman was admitted to the hospital with COVID-19 pneumonia. Two days later, she was intubated and VV-ECMO was initiated due to treatment-resistant acute respiratory failure;a 28Fr CrescentTM dual-lumen cannula (Medtronic, MN) was inserted through the left subclavian vein and connected to a centrifugal oxygen pump with a centrifugal oxygenator. Within six weeks after onset, the patient was unable to be weaned from the ventilator and was transferred to our center with ECMO connected for consideration of lung transplantation. Two days after transfer, the patient developed acute aphasia, altered mental status, disturbed consciousness, and left arm seizures. A suction sound was heard from the left subclavian cannula insertion site and the ECMO bubble detector alarmed, but local inspection, chest X-rays, and CT scans of the brain and chest showed no obvious abnormalities. The patient was reintubated for encephalopathy and subsequently underwent a tracheostomy. The patient regained normal neurological function over the next 7 days. However, the air bubble sensor alarmed and suction sound was heard at the cannulation site again, and air bubbles were seen in the oxygenator. Due to concerns about air entrapment and cannula failure, we changed to a dual-canal VV-ECMO configuration using a right internal cervical and a left femoral cannula. The removed cannula had a 2 cm fracture distal to the skin insertion site. After resumption of ECMO, no new neurological episodes occurred. While awaiting lung transplantation, the patient died due to sepsis and multiple organ failure. An autopsy revealed a possible cause of cerebrovascular disease patent foramen ovale and air embolism to the brain. If a patient has been on ECMO for a long time and the bubble sensor warns of air detection, cannula breakage and impending air embolism should be suspected clinically, even if the defect is not found on examination and is not evident on imaging. If the COVID-19 epidemic continues, increased transport events may increase ECMO cannula breakage.