Abstract
Recent evolution in extracorporeal supports allows bridging to lung or heart and lung transplant in a consistent number of cases. However, long term results of these transplants have been rarely reported. Aim of present study was to analyse early and long term results in a small n° of lung transplant recipients (LTR) which have been bridged with extracorporeal devices. Nine patients (8 males, mean age39.5) have been transplanted (4SL, 2DL, 3HL). Transplant indications were: UIP (5), PAH (3), bronchiectasis (1). This latter patient (HL) died 3 days after surgery of MOF due to sepsia. 8 patients are alive at a mean of 16 months (min 3.5 - max 33).
Early complications included: Re-op for bleeding (1/8) CRYMINE (5/8), slow weaning with need of tracheotomy (7/8), graft infections (1/8), acute renal failure with need for renal replacement therapy in ICU (4/8).
Medium long term-complications included: AR>2 (2/8), CMV pneumonia/reactivation (4/8), Thrombosis (2/8), EBV related haemophagocytic syndrome (1/8); colonization with Ps. aeruginosa or A. fumigatus (2/8) end stage renal failure (RF) (1/8). Two out of 8 patients had an increased in anti HLA class I or II antibody titres (>10%).
At last follow-up visit graft function was >90% of best in 6/8 patient while 2 patients BOS-0p. Mean GFR (MDRD formula) was 54ml/min range between15 and 85.
In conclusion: long term survival of ECMO bridged LTR is satisfactory, with good graft function. However, early post transplant period is almost invariably complicated by CRYMINE and slow weaning, and a high degree of chronic RF is detected.
- © 2011 ERS