Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients

Hsao Hsun Hsu, Jin Shing Chen, Wen Je Ko, Shu Chien Huang, Shuenn Wen Kuo, Pei Ming Huang, Nai Hsin Chi, Chin Chih Chang, Robert J. Chen, Yung Chie Lee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Survival after cadaveric lung transplantation (LTx) in respiratory failure recipients who were already dependent on ventilation support prior to transplantation is poor, with a relatively high rate of surgical mortality and morbidity. In this study, we sought to describe the short-term outcomes of bilateral sequential LTx (BSLTx) under extracorporeal membrane oxygenation (ECMO) support in a consecutive series of preoperative respiratory failure patients. Methods: Between July 2006 and July 2008, we performed BSLTx under venoarterious (VA) ECMO support in 10 respiratory failure patients with various lung diseases. Prior to transplantation, 6 patients depended on invasive mechanical ventilation support and the others (40%) needed noninvasive positive pressure ventilation to maintain adequate gas exchange. Their mean age was 40.9 years and the mean observation period was 16.4 months. Results: Except for 1 ECMO circuit that had been set up in the intensive care unit for pulmonary crisis 5 days prior to transplantation, most ECMO (90%) circuits were set up in the operating theater prior to pneumonectomy of native lung during transplantation. Patients were successfully weaned off ECMO circuits immediately after transplantation in 8 cases, and within 1 day (1/10 patients) and after 9 days (1/10 patients) due to severe reperfusion lung edema following transplantation. The mean duration of ECMO support in those successfully weaned off in the operating theater (n = 8) was 7.8 hours. The average duration of intensive care unit stay (n = 10) was 43.1 days (range, 35 to 162 days) and hospital stay (n = 10) was 70 days (range, 20 to 86 days). Although 4 patients (40%) had different degrees of complicated postoperative courses unrelated to ECMO, all patients were discharged home postoperatively. The mean forced vital capacity and the forced expiratory volume in 1 second both increased significantly postoperatively. The cumulative survival rates at 3 months and at 12 months post-transplantation were 100% and 90%. Conclusions: Although BSLTx in this critical population has varied surgical complications and prolonged length of postoperative ICU and hospital stays, all the patients observed in this study could tolerate the transplant procedures under VA ECMO support with promising pulmonary function and satisfactory short-term outcome.

Original languageEnglish
Article numberR129
JournalCritical Care
Volume13
Issue number4
DOIs
Publication statusPublished - Aug 6 2009
Externally publishedYes

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Lung Transplantation
Extracorporeal Membrane Oxygenation
Mechanical Ventilators
Transplantation
Respiratory Insufficiency
Lung
Intensive Care Units
Length of Stay
Pneumonectomy
Positive-Pressure Respiration
Vital Capacity
Forced Expiratory Volume
Artificial Respiration
Lung Diseases
Reperfusion
Ventilation
Edema
Survival Rate
Gases
Observation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Hsu, H. H., Chen, J. S., Ko, W. J., Huang, S. C., Kuo, S. W., Huang, P. M., ... Lee, Y. C. (2009). Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients. Critical Care, 13(4), [R129]. https://doi.org/10.1186/cc7989

Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients. / Hsu, Hsao Hsun; Chen, Jin Shing; Ko, Wen Je; Huang, Shu Chien; Kuo, Shuenn Wen; Huang, Pei Ming; Chi, Nai Hsin; Chang, Chin Chih; Chen, Robert J.; Lee, Yung Chie.

In: Critical Care, Vol. 13, No. 4, R129, 06.08.2009.

Research output: Contribution to journalArticle

Hsu, HH, Chen, JS, Ko, WJ, Huang, SC, Kuo, SW, Huang, PM, Chi, NH, Chang, CC, Chen, RJ & Lee, YC 2009, 'Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients', Critical Care, vol. 13, no. 4, R129. https://doi.org/10.1186/cc7989
Hsu HH, Chen JS, Ko WJ, Huang SC, Kuo SW, Huang PM et al. Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients. Critical Care. 2009 Aug 6;13(4). R129. https://doi.org/10.1186/cc7989
Hsu, Hsao Hsun ; Chen, Jin Shing ; Ko, Wen Je ; Huang, Shu Chien ; Kuo, Shuenn Wen ; Huang, Pei Ming ; Chi, Nai Hsin ; Chang, Chin Chih ; Chen, Robert J. ; Lee, Yung Chie. / Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients. In: Critical Care. 2009 ; Vol. 13, No. 4.
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abstract = "Introduction: Survival after cadaveric lung transplantation (LTx) in respiratory failure recipients who were already dependent on ventilation support prior to transplantation is poor, with a relatively high rate of surgical mortality and morbidity. In this study, we sought to describe the short-term outcomes of bilateral sequential LTx (BSLTx) under extracorporeal membrane oxygenation (ECMO) support in a consecutive series of preoperative respiratory failure patients. Methods: Between July 2006 and July 2008, we performed BSLTx under venoarterious (VA) ECMO support in 10 respiratory failure patients with various lung diseases. Prior to transplantation, 6 patients depended on invasive mechanical ventilation support and the others (40{\%}) needed noninvasive positive pressure ventilation to maintain adequate gas exchange. Their mean age was 40.9 years and the mean observation period was 16.4 months. Results: Except for 1 ECMO circuit that had been set up in the intensive care unit for pulmonary crisis 5 days prior to transplantation, most ECMO (90{\%}) circuits were set up in the operating theater prior to pneumonectomy of native lung during transplantation. Patients were successfully weaned off ECMO circuits immediately after transplantation in 8 cases, and within 1 day (1/10 patients) and after 9 days (1/10 patients) due to severe reperfusion lung edema following transplantation. The mean duration of ECMO support in those successfully weaned off in the operating theater (n = 8) was 7.8 hours. The average duration of intensive care unit stay (n = 10) was 43.1 days (range, 35 to 162 days) and hospital stay (n = 10) was 70 days (range, 20 to 86 days). Although 4 patients (40{\%}) had different degrees of complicated postoperative courses unrelated to ECMO, all patients were discharged home postoperatively. The mean forced vital capacity and the forced expiratory volume in 1 second both increased significantly postoperatively. The cumulative survival rates at 3 months and at 12 months post-transplantation were 100{\%} and 90{\%}. Conclusions: Although BSLTx in this critical population has varied surgical complications and prolonged length of postoperative ICU and hospital stays, all the patients observed in this study could tolerate the transplant procedures under VA ECMO support with promising pulmonary function and satisfactory short-term outcome.",
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AU - Ko, Wen Je

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AU - Kuo, Shuenn Wen

AU - Huang, Pei Ming

AU - Chi, Nai Hsin

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N2 - Introduction: Survival after cadaveric lung transplantation (LTx) in respiratory failure recipients who were already dependent on ventilation support prior to transplantation is poor, with a relatively high rate of surgical mortality and morbidity. In this study, we sought to describe the short-term outcomes of bilateral sequential LTx (BSLTx) under extracorporeal membrane oxygenation (ECMO) support in a consecutive series of preoperative respiratory failure patients. Methods: Between July 2006 and July 2008, we performed BSLTx under venoarterious (VA) ECMO support in 10 respiratory failure patients with various lung diseases. Prior to transplantation, 6 patients depended on invasive mechanical ventilation support and the others (40%) needed noninvasive positive pressure ventilation to maintain adequate gas exchange. Their mean age was 40.9 years and the mean observation period was 16.4 months. Results: Except for 1 ECMO circuit that had been set up in the intensive care unit for pulmonary crisis 5 days prior to transplantation, most ECMO (90%) circuits were set up in the operating theater prior to pneumonectomy of native lung during transplantation. Patients were successfully weaned off ECMO circuits immediately after transplantation in 8 cases, and within 1 day (1/10 patients) and after 9 days (1/10 patients) due to severe reperfusion lung edema following transplantation. The mean duration of ECMO support in those successfully weaned off in the operating theater (n = 8) was 7.8 hours. The average duration of intensive care unit stay (n = 10) was 43.1 days (range, 35 to 162 days) and hospital stay (n = 10) was 70 days (range, 20 to 86 days). Although 4 patients (40%) had different degrees of complicated postoperative courses unrelated to ECMO, all patients were discharged home postoperatively. The mean forced vital capacity and the forced expiratory volume in 1 second both increased significantly postoperatively. The cumulative survival rates at 3 months and at 12 months post-transplantation were 100% and 90%. Conclusions: Although BSLTx in this critical population has varied surgical complications and prolonged length of postoperative ICU and hospital stays, all the patients observed in this study could tolerate the transplant procedures under VA ECMO support with promising pulmonary function and satisfactory short-term outcome.

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