Universität zu Köln

Sabashnikov, Anton, Mohite, Prashant N., Zeriouh, Mohamed, Zych, Bartlomiej, Garcia-Saez, Diana, Maier, Johanna, Weymann, Alexander, Fatullayev, Javid, Mahesh, Balakrishnan, Popov, Aron-Frederik ORCID: 0000-0003-4226-3004, Stock, Ulrich, De Robertis, Fabio, Bahrami, Toufan, Wahlers, Thorsten, Carby, Martin, Simon, Andre R. and Reed, Anna (2019). The role of extracorporeal life support in the management with severe idiopathic pulmonary artery hypertension undergoing lung transplantation: are those patients referred too late? J. Thorac. Dis., 11. S. S929 - 9. SHATIN: AME PUBL CO. ISSN 2077-6624

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Abstract

Background: Idiopathic pulmonary artery hypertension (iPAH) is a relatively minor indication for lung transplantation (LTx) with comparatively poorer outcomes. Extracorporeal life support (ECLS) in various forms is increasingly being used in the management of this entity. However, the data and experience with this therapy remains limited. We evaluated the role of ECLS in the management of severe iPAH patients as a bridge to LTx as well as post LTx support. Methods: A retrospective analysis of iPAH patients that received LTx between March 2008 and March 2014 was performed. Early- and mid-term outcomes were analyzed for this patient cohort. Also, early and mid-term outcomes after LTx were compared to the control group of patients with other diagnoses using unadjusted analysis and 1: 3 propensity score matching. Results: Of 321 LTx performed during the study period in our centre 15 patients had iPAH as a cause of end-stage lung disease. Four iPAH (27%) patients were bridged to LTx utilizing ECLS in the form of veno-arterial ECMO and extra-corporeal CO2 removal device, whereas 9 patients (60%) required ECLS support for primary graft dysfunction (PGD) after surgery. Patients with iPAH required more frequently on-pump LTx, both pre and post LTx ECLS, and had significantly lower pO(2)/FiO(2) ratio at 24, 48 and 72 hours after LTx. Also iPAH patients had significantly longer ICU and hospital stay. Whereas the incidence of postoperative bronchiolitis obliterans syndrome (BOS) and rejection was comparable to the control group, overall cumulative survival with up to 6 years follow-up was significantly poorer in the iPAH group. After propensity score matching, the results in terms of postoperative outcomes remained as in the unadjusted analysis. Conclusions: ECLS is an essential tool in the armamentarium of any lung transplant program treating iPAH with a potential of bridge patients to transplantation and to overcome graft dysfunction after LTx. Despite utilization of ECLS in the management of iPAH, the outcomes in terms of primary graft failure and survival remain poor compared to patients with other diagnoses.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sabashnikov, Anton UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohite, Prashant N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeriouh, Mohamed UNSPECIFIED UNSPECIFIED UNSPECIFIED Zych, Bartlomiej UNSPECIFIED UNSPECIFIED UNSPECIFIED Garcia-Saez, Diana UNSPECIFIED UNSPECIFIED UNSPECIFIED Maier, Johanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Weymann, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Fatullayev, Javid UNSPECIFIED UNSPECIFIED UNSPECIFIED Mahesh, Balakrishnan UNSPECIFIED UNSPECIFIED UNSPECIFIED Popov, Aron-Frederik UNSPECIFIED orcid.org/0000-0003-4226-3004 UNSPECIFIED Stock, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED De Robertis, Fabio UNSPECIFIED UNSPECIFIED UNSPECIFIED Bahrami, Toufan UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Carby, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Simon, Andre R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Reed, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-151773
DOI:	10.21037/jtd.2019.04.58
Journal or Publication Title:	J. Thorac. Dis.
Volume:	11
Page Range:	S. S929 - 9
Date:	2019
Publisher:	AME PUBL CO
Place of Publication:	SHATIN
ISSN:	2077-6624
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTERNATIONAL SOCIETY; MEMBRANE-OXYGENATION; RISK-FACTORS; ADULT LUNG; MORTALITY; SURVIVAL; REGISTRY; BRIDGE; HEART Multiple languages Respiratory System Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15177