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Septic shock – A contraindication for bridge to transplant?

Franziska Kaestner, Nicole Olewczynska, Ralf Kaiser, Philip Böhmer, Ingo Stehle, Katharina Rentz, Sven Henschke, Sebastian Fähndrich, Hans-Joachim Schäfers, Frank Langer, Heinrike Wilkens, Robert Bals, Philipp M. Lepper
European Respiratory Journal 2014 44: P2464; DOI:
Franziska Kaestner
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Nicole Olewczynska
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Ralf Kaiser
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Philip Böhmer
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Ingo Stehle
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Katharina Rentz
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Sven Henschke
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Sebastian Fähndrich
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Hans-Joachim Schäfers
2Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg, Saarland, Germany
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Frank Langer
2Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg, Saarland, Germany
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Heinrike Wilkens
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Robert Bals
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Philipp M. Lepper
1Department of Internal Medicine V, University Hospital of Saarland, Homburg, Saarland, Germany
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Abstract

Aim: To show first results of patients in septic shock being bridged to lung transplantation

(ltx) via extra corporal membrane oxygenation (ECMO).

Methods: A retrospective, single-center study observing septic patients in 2012 and 2013

taken on ECMO and being transplanted.

Results: 12 patients were included, 1 died on ECMO prior to ltx, 2 died in the first days

post transplantation. 7 were female; the mean age was 46. 5

patients suffered from mucoviscidosis, 3 had fibrosis, 2 COPD and another 2 PAH

respectively bronchiectasis. The mean time on the waiting list was 15.7 month, mean lung

allocation score 90 points. With 8 patients the sepsis was

classified as septic shock with the use of catecholamines. 5 patients had 4 SIRS

points, 4 had 3 and 2 had 2 points (one was connected to ECMO prior to the

transfer to our hospital). Mean time on ECMO was 35.5 days. Cannulation was in

all patients veno-venous and had to be changed in veno-(veno)-arterial in 3

patients. 8 patients did not need ECMO after ltx. The mean time on ICU after

ltx counted 44.5 days.

Conclusion: Infection and even more sepsis are commonly seen as at least relative

contraindications for taking patients on ECMO and bridging them to ltx. Main

reasons are the high mortality rate of septic patients on ECMO and the worse

outcomes after ltx. We were able to show that nearly all patients (11 from 12) could

be bridged to ltx and the overall mortality rate was relatively low (3 out of

12 died). There was no major correlation between high SIRS points, more ECMO

days or use of catecholamines and longer ICU stay or death. Further

consideration of the data is needed, in order to identify clues for best

outcomes in times of scarce resources.

  • Transplantation
  • Sepsis
  • Critically ill patients
  • © 2014 ERS
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Septic shock – A contraindication for bridge to transplant?
Franziska Kaestner, Nicole Olewczynska, Ralf Kaiser, Philip Böhmer, Ingo Stehle, Katharina Rentz, Sven Henschke, Sebastian Fähndrich, Hans-Joachim Schäfers, Frank Langer, Heinrike Wilkens, Robert Bals, Philipp M. Lepper
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2464;

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Septic shock – A contraindication for bridge to transplant?
Franziska Kaestner, Nicole Olewczynska, Ralf Kaiser, Philip Böhmer, Ingo Stehle, Katharina Rentz, Sven Henschke, Sebastian Fähndrich, Hans-Joachim Schäfers, Frank Langer, Heinrike Wilkens, Robert Bals, Philipp M. Lepper
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2464;
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More in this TOC Section

  • Oto score and medium-term outcomes in lung transplantation
  • Differences in the lipidomic profile of bronchial washing (BW) and bronchoalveolar lavage (BAL) in lung transplanted patients
  • Diffusion capacity as a predictor of prognosis after onset of CLAD
Show more 8.2 Transplantation

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