Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: An evolving strategy in the management of rapidly advancing pulmonary disease
Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: An evolving strategy in the management of rapidly advancing pulmonary disease
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DOI：
10.1016/j.jtcvs.2014.08.072
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发表时间：
2015-01-01
影响因子：
6
通讯作者：
Bhama, Jay K.
中科院分区：
文献类型：
--
作者：
Hayanga, Awori J.;Aboagye, Jonathan;Bhama, Jay K.
目的：技术的进步使体外膜肺氧合作为肺移植桥梁的应用重新兴起。方法：通过使用器官共享联合网络数据库，我们分析了2000至2011年间接受肺移植的12,458名成人的数据。患者被分成两组：119名患者使用体外膜氧合进行移植，12339名患者未使用体外膜氧合。研究期间分为四个三年间隔：2000年至2002年、2003年至2005年、2006年至2008年和2009年至2011年。采用Kaplan-Meier分析，比较两组患者在每一时间段的1年生存率。结果：在所有受者中，4例(3.4%)在2000年至2002年间桥接，17例(14.3%)在2003年至2005年间桥接，31例(26.1%)在2006年至2008年间桥接，67例(56.3%)在2009年至2011年间桥接。使用体外膜氧合搭桥的受者更有可能更年轻，更容易患糖尿病，并有更高的血肌酐和胆红素水平。使用体外膜氧合的患者术后1年生存率显著降低：25.0%对81.0%(2000-2002)，47.1%对84.2%(2006-2008)，74.4%对85.7%(2009-2011)。结论：在过去几年中，使用体外膜氧合作为肺移植桥梁的短期存活率显著提高。
Objective: Improvements in technology have led to a resurgence in the use of extracorporeal membrane oxygenation as a bridge to lung transplantation. By using a national registry, we sought to evaluate how short-term survival has evolved using this strategy.Methods: With the use of the United Network for Organ Sharing database, we analyzed data from 12,458 adults who underwent lung transplantation between 2000 and 2011. Patients were categorized into 2 cohorts: 119 patients who were bridged to transplantation using extracorporeal membrane oxygenation and 12,339 patients who were not. The study period was divided into four 3-year intervals: 2000 to 2002, 2003 to 2005, 2006 to 2008, and 2009 to 2011. With Kaplan-Meier analysis, 1-year survival was compared for the 2 cohorts of patients in each of the time periods. A propensity score-adjusted Cox regression model was used to estimate the risk of 1-year mortality.Results: Of the total number of recipients, 4 (3.4%) were bridged between 2000 and 2002, 17 (14.3%) were bridged between 2003 and 2005, 31 (26.1%) were bridged between 2006 and 2008, and 67 were bridged (56.3%) between 2009 and 2011. Recipients bridged using extracorporeal membrane oxygenation were more likely to be younger and diabetic and to have higher serum creatinine and bilirubin levels. The 1-year survival for those bridged with extracorporeal membrane oxygenation was significantly lower in subsequent periods: 25.0% versus 81.0% (2000-2002), 47.1% versus 84.2% (2006-2008), and 74.4% versus 85.7% (2009-2011). However, this survival progressively increased with each period, as did the number of patients bridged using extracorporeal membrane oxygenation.Conclusions: Short-term survival with the use of extracorporeal membrane oxygenation as a bridge to lung transplantation has significantly improved over the past few years.