Extracorporeal life support as a bridge to lung transplantation-experience of a high-volume transplant center
Extracorporeal life support as a bridge to lung transplantation-experience of a high-volume transplant center
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DOI：
10.1016/j.jtcvs.2017.09.161
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发表时间：
2018-03-01
影响因子：
6
通讯作者：
Cypel, Marcelo
中科院分区：
文献类型：
--
作者：
Hoetzenecker, Konrad;Donahoe, Laura;Cypel, Marcelo
目的：体外生命支持（ECLS）越来越多地用于缓解等待肺移植（LTx）的病情恶化的患者，然而，对这种做法的系统描述很少。因此，我们旨在回顾过去 10 年的机构经验。方法：在这个案例系列中，我们纳入了所有接受 ECLS 并意图过渡到 LTx 的成年人。数据取自患者图表以及我们机构的 ECLS 和移植数据库。结果：2006 年 1 月至 2016 年 9 月期间，我们机构进行了 1111 例 LTx。 ECLS 用于 71 名成人，旨在过渡到 LTx；其中，11 例（16%）过渡到再移植。 LTx 之前 ECLS 的中位持续时间为 10 天（范围，0-95）。我们对 23 名患者 (32%) 使用了单双腔静脉插管。 13 名肺动脉高压患者中的 9 名 (69%) 通过中央肺动脉桥接至左心房 Novalung。 25 名患者 (35%) 在 ECLS 期间拔管，26 名患者 (37%) 活动。 63 名患者 (89%) 经 LTx 存活。意向治疗的生存率为 66%（1 年）、58%（3 年）和 48%（5 年）。与首次 LTx 相比，接受 ECLS 桥接再移植的患者的生存期显着缩短（中位生存期为 15 个月（95% CI，0-31）与 60 个月（95% CI，37-83）；P = 0.041）。结论：根据我们中心的经验，ECLS 桥接首次肺移植可在精心挑选的患者中带来良好的短期和长期结果。相比之下，我们的数据表明 ECLS 作为再移植的桥梁应谨慎使用。
Objectives: Extracorporeal life support (ECLS) is increasingly used to bridge deteriorating patients awaiting lung transplantation (LTx), however, few systematic descriptions of this practice exist. We therefore aimed to review our institutional experience over the past 10 years.Methods: In this case series, we included all adults who received ECLS with the intent to bridge to LTx. Data were retrieved from patient charts and our institutional ECLS and transplant databases.Results: Between January 2006 and September 2016, 1111 LTx were performed in our institution. ECLS was used in 71 adults with the intention to bridge to LTx; of these, 11 (16%) were bridged to retransplantation. The median duration of ECLS before LTx was 10 days (range, 0-95). We used a single dual-lumen venous cannula in 23 patients (32%). Nine of 13 patients (69%) with pulmonary hypertension were bridged by central pulmonary artery to left atrium Novalung. Twenty-five patients (35%) were extubated while on ECLS and 26 patients (37%) were mobilized. Sixty-three patients (89%) survived to LTx. Survival by intention to treat was 66%(1 year), 58%(3 years) and 48%(5 years). Survival was significantly shorter in patients undergoing ECLS bridge to retransplantation compared with first LTx (median survival, 15 months (95% CI, 0-31) versus 60 months (95% CI, 37-83); P = .041).Conclusions: In our center experience, ECLS bridge to first lung transplant leads to good short-term and long-term outcomes in carefully selected patients. In contrast, our data suggest that ECLS as a bridge to retransplantation should be used with caution.