Does reperfusion injury still cause significant mortality after lung transplantation?
Gorav Ailawadi, Christine L. Lau, Lynn M. Fedourk, Philip W. Smith, Courtney Kuhn, Benjamin D. Kozower, John A. Kern, Benjamin B. Peeler, Irving L. Kron, David R. Jones; TCV Surgery, University of Virginia, Charlottesville, VA
Comment on this Abstract
Objective: Severe reperfusion injury (RI) is a major cause of early mortality following lung transplantation (LTX) with mortality rates of 40%. The purpose of this investigation was to identify if our improved 1-year survival of following LTX is related to better treatment of reperfusion injury.
Methods: The records of consecutive adult LTX recipients (N=291) from January 1990 to August 2006 were reviewed. LTX recipients prior to March 2000 (early era, N=136) were compared to recipients after March 2000 (current era, N=155) when we reported selective early institution of ECMO (extracorporeal membrane oxygenation) can improve survival with RI defined by oxygenation index >7 (where oxygenation index = (percent inspired oxygen)*(mean airway pressure)/ (partial pressure of oxygen). Risk factors for RI, treatment of RI, and 30-day mortality were compared between time periods using X2 or Fisher’s where appropriate.
Results: 30-day mortality following LTX improved from 11.8% in the early era to 3.9% in the current era (P=.02). In patients without RI, mortality was low and did not change in the two eras. Although the incidence of RI did not change between the eras, patients with RI had less mortality in the current era (11.4% vs. 38.2 %, P=.02). Primary pulmonary hypertension was more common in the early era (10% [14/136] vs. 2% [3/155], P=.005). Double lung transplantation was more common in the current era (26% [41/155] vs. 16% [22/136], P=.05). Mean ischemic time increased from 205.6 + 78.5 minutes in the early time period to 286.32 + 88.3 minutes in the later time period (P=.0001). Other variables were not different between the early and current eras including the utilization of ECMO, nitric oxide, and epoprostenol (11.0% [15/136] vs. 10.3% [16/155]). The mortality of RI patients requiring ECMO significantly improved in the current era (25.0% vs. 80.0%, P=.03). The median duration of ECMO was significantly shorter in the current era (30.6±8.0 vs. 89±29.8, P=.02).
Conclusion: Improved early survival following lung transplantation is due to improvements in the treatment of severe reperfusion injury including better survival with ECMO.
| Outcome | Early Era(n=136) | Current Era(n=151) | P-value |
| Early Mortality (30-day) | 11.8% (16/136) | 3.9% (6/136) | 0.02 |
| Incidence of RI | 25% (34/136) | 22.6%(35/136) | 0.73 |
| Mortality with RI | 38.2% (13/35) | 11.4% (4/35) | 0.02 |
| Mortality of RI treated with ECMO | 80.0% (8/10) | 25.0% (3/12) | 0.03 |
| Duration of ECMO | 89 ± 29.8 hrs | 30.6 ± 8.0 hrs | 0.02 |
Data listed as %(n). ECMO duration listed as mean ± S.D.
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