Risk Factors of Post-Operative Extracorporeal Membrane Oxygenation Support after Lung Transplantation: A Retrospective Analysis

Background: Extracorporeal membrane oxygenation (ECMO) is an effective adjuvant therapy for cardiopulmonary support during the period of lung transplantation (LTx). However, factors associated with the application of ECMO after LTx remain controversial. The purpose of this study is to clarify the risk factors of post-operative ECMO support and to evaluate the outcomes. Methods: It was a hospital, single-center, retrospective study. 266 patients underwent LTx supported by ECMO were included. According to whether or not the patients received continourly ECMO support after the surgery, the enrolled patients were further divided into intra-operative ECMO group (group I, 105 cases) and post-operative ECMO group (group P, 161 cases). The peri-operative data of the donors and recipients were collected. The independent risk factors associated with post-operative ECMO support during LTx were identified. The relationship between primary graft dysfunction (PGD)/post-operative survival and duration of ECMO support was also analyzed. Results: Prolonged donor ventilation ≥ 5 days, pre-operative recipient mechanical ventilation, bilateral lung transplantation (BLT), veno-venous (V-V) ECMO and PGD in recipient were independent risk factors for post-operative ECMO support. The risk of PGD and post-operative death increased along with the increase of ECMO bypass time, and the mortality risk in group P was 2.33 (95% confidence interval: 1.16 - 4.67) times as that in group I. Conclusions: Mechanical ventilation for donor ≥ 5 days, pre-operative mechanical ventilation, BLT, V-V-ECMO and PGD in recipient were independent risk factors for post-operative ECMO support after LTx, and post-operative ECMO could not reduce recipients’ hospital mortality.

Association of cardiac disease with the risk of post-lung transplantation mortality in Chinese recipients aged over 65 years

The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.

A monolithic single-chip point-of-care platform for metabolomic prostate cancer detection

There is a global unmet need for rapid and cost-effective prognostic and diagnostic tools that can be used at the bedside or in the doctor’s office to reduce the impact of serious disease.Many cancers are diagnosed late,leading to costly treatment and reduced life expectancy.With prostate cancer,the absence of a reliable test has inhibited the adoption of screening programs.We report a microelectronic point-of-care metabolite biomarker measurement platform and use it for prostate cancer detection.The platform,using an array of photodetectors configured to operate with targeted,multiplexed,colorimetric assays confined in monolithically integrated passive microfluidic channels,completes a combined assay of 4 metabolites in a drop of human plasma in under 2 min.A preliminary clinical study using L-amino acids,glutamate,choline,and sarcosine was used to train a cross-validated random forest algorithm.The system demonstrated sensitivity to prostate cancer of 94%with a specificity of 70%and an area under the curve of 0.78.The technology can implement many similar assay panels and hence has the potential to revolutionize low-cost,rapid,point-of-care testing.