Complications related to extracorporeal life support in lung transplantation : single-center analysis
2023 Journal of Thoracic Disease. All rights reserved..
Background: Extracorporeal life support (ECLS) is not routinely used at our center during sequential single-lung transplantation (LTx), but is restricted to anticipate and overcome hemodynamic and respiratory problems occurring peri-operatively. In this retrospective descriptive cohort study, we aim to describe our single-center experience with ECLS in LTx, analyzing ECLS-related complications.
Methods: All transplantations with peri-operative ECLS use [2010-2020] were retrospectively analyzed. Multi-organ and heart-lung transplantation were excluded. Demographics, support type and indications are described. Complications are categorized according to the underlying nature and type. Data are presented as median [interquartile range (IQR)]. Kaplan-Meier was used for survival analysis.
Results: The overall use of ECLS was 22% (156/703 patients) with a mean age of 52 years (IQR, 36-59 years). Transplant indications in ECLS cohort were interstitial lung disease (38%; n=60), chronic obstructive pulmonary disease (COPD) (19%; n=29), cystic fibrosis (17%; n=26) and others (26%; n=41). Per indication, 94% (15/16) of pulmonary arterial hypertension patients required ECLS, whereas only 8% (29/382) of COPD patients did. In 16% (25/156) of supported patients, veno-venous extracorporeal membrane oxygenation was initiated, while 77% (120/156) required veno-arterial support, and 7% (11/156) cardiopulmonary bypass. Thirty-day mortality was 6% (9/156). Sixteen percent (25/156) of patients were bridged to transplantation on ECLS and 24% (37/156) required post-operative support. Main reasons to use ECLS were intra-operative hemodynamic instability (53%; n=82), ventilation/oxygenation problems (22%; n=34) and reperfusion edema (17%; n=26). Overall incidence of patients with at least one ECLS-related complication was 67% (n=104). Most common complications were hemothorax (25%; n=39), need for continuous renal replacement therapy (19%; n=30), and thromboembolism (14%; n=22).
Conclusions: ECLS was required in 22% of LTxs, with a reported ECLS-related complication rate of 67%, of which the most common was hemothorax. Larger databases are needed to further analyze complications and develop tailored deployment strategies for ECLS-use in LTx.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
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| Enthalten in: |
Journal of thoracic disease - 15(2023), 11 vom: 30. Nov., Seite 6301-6316 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Orlitová, Michaela [VerfasserIn] |
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| Links: |
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| Themen: |
Complications |
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| Anmerkungen: |
Date Revised 13.12.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.21037/jtd-23-443 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM365810533 |
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| 100 | 1 | |a Orlitová, Michaela |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Complications related to extracorporeal life support in lung transplantation |b single-center analysis |
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| 500 | |a Date Revised 13.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a 2023 Journal of Thoracic Disease. All rights reserved. | ||
| 520 | |a Background: Extracorporeal life support (ECLS) is not routinely used at our center during sequential single-lung transplantation (LTx), but is restricted to anticipate and overcome hemodynamic and respiratory problems occurring peri-operatively. In this retrospective descriptive cohort study, we aim to describe our single-center experience with ECLS in LTx, analyzing ECLS-related complications | ||
| 520 | |a Methods: All transplantations with peri-operative ECLS use [2010-2020] were retrospectively analyzed. Multi-organ and heart-lung transplantation were excluded. Demographics, support type and indications are described. Complications are categorized according to the underlying nature and type. Data are presented as median [interquartile range (IQR)]. Kaplan-Meier was used for survival analysis | ||
| 520 | |a Results: The overall use of ECLS was 22% (156/703 patients) with a mean age of 52 years (IQR, 36-59 years). Transplant indications in ECLS cohort were interstitial lung disease (38%; n=60), chronic obstructive pulmonary disease (COPD) (19%; n=29), cystic fibrosis (17%; n=26) and others (26%; n=41). Per indication, 94% (15/16) of pulmonary arterial hypertension patients required ECLS, whereas only 8% (29/382) of COPD patients did. In 16% (25/156) of supported patients, veno-venous extracorporeal membrane oxygenation was initiated, while 77% (120/156) required veno-arterial support, and 7% (11/156) cardiopulmonary bypass. Thirty-day mortality was 6% (9/156). Sixteen percent (25/156) of patients were bridged to transplantation on ECLS and 24% (37/156) required post-operative support. Main reasons to use ECLS were intra-operative hemodynamic instability (53%; n=82), ventilation/oxygenation problems (22%; n=34) and reperfusion edema (17%; n=26). Overall incidence of patients with at least one ECLS-related complication was 67% (n=104). Most common complications were hemothorax (25%; n=39), need for continuous renal replacement therapy (19%; n=30), and thromboembolism (14%; n=22) | ||
| 520 | |a Conclusions: ECLS was required in 22% of LTxs, with a reported ECLS-related complication rate of 67%, of which the most common was hemothorax. Larger databases are needed to further analyze complications and develop tailored deployment strategies for ECLS-use in LTx | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Complications | |
| 650 | 4 | |a extracorporeal life support (ECLS) | |
| 650 | 4 | |a lung transplantation (LTx) | |
| 700 | 1 | |a Goos, Wout |e verfasserin |4 aut | |
| 700 | 1 | |a Van Slambrouck, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Degezelle, Karlien |e verfasserin |4 aut | |
| 700 | 1 | |a Vanluyten, Cedric |e verfasserin |4 aut | |
| 700 | 1 | |a Vandervelde, Christelle |e verfasserin |4 aut | |
| 700 | 1 | |a De Beule, Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Jin, Xin |e verfasserin |4 aut | |
| 700 | 1 | |a Berkmans, Evelien |e verfasserin |4 aut | |
| 700 | 1 | |a De Leyn, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Decaluwé, Herbert |e verfasserin |4 aut | |
| 700 | 1 | |a Van Veer, Hans |e verfasserin |4 aut | |
| 700 | 1 | |a Depypere, Lieven |e verfasserin |4 aut | |
| 700 | 1 | |a Verleden, Geert M |e verfasserin |4 aut | |
| 700 | 1 | |a Godinas, Laurent |e verfasserin |4 aut | |
| 700 | 1 | |a Vos, Robin |e verfasserin |4 aut | |
| 700 | 1 | |a De Troy, Erwin |e verfasserin |4 aut | |
| 700 | 1 | |a Dauwe, Dieter F |e verfasserin |4 aut | |
| 700 | 1 | |a Ingels, Catherine |e verfasserin |4 aut | |
| 700 | 1 | |a Meersseman, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Hermans, Greet |e verfasserin |4 aut | |
| 700 | 1 | |a Wauters, Joost |e verfasserin |4 aut | |
| 700 | 1 | |a Rega, Filip |e verfasserin |4 aut | |
| 700 | 1 | |a Meyns, Bart |e verfasserin |4 aut | |
| 700 | 1 | |a Verbelen, Tom |e verfasserin |4 aut | |
| 700 | 1 | |a Van Raemdonck, Dirk E |e verfasserin |4 aut | |
| 700 | 1 | |a Neyrinck, Arne P |e verfasserin |4 aut | |
| 700 | 1 | |a Ceulemans, Laurens J |e verfasserin |4 aut | |
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