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.

Green channel of human organ transport improved the utilization rate of Chinese citizens’donated lungs:a single-center data analysis

To the Editor:Organ donation after the citizen’s death program was fully launched in China in 2015.According to the allocation regulations of donated organs,all donated lungs must be allocated through the China Organ Transplant Response System(COTRS,www.cot.org.cn).[1]To fully optimize the implementation of organ transportation sharing policy and coordinate multiple government departments and social groups involved in the process,the"Green Channel of Human Organ Transport(GCHOT)"was established on May 6th,2016 in China[Supplementary Figure 1,http://links.lww.com/CM9/A431].[2]In this study,we reviewed and compared the status of lung transportation between the pre-and post-GCHOT periods based on data collected from the largest lung transplantation(LT)center in Wuxi,Jiangsu,China,with the aim of introducing the detailed process and implementation of GCHOT in China.