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Ann Thorac Surg 2005;80:1872-1880
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Improved Results Treating Lung Allograft Failure With Venovenous Extracorporeal Membrane Oxygenation

Matthew G. Hartwig, MD a , James Z. Appel, III, MD a , Edward Cantu, III, MD a , Sinan Simsir, MD a , Shu S. Lin, MD, PhD a , Chong-Chao Hsieh, MD a , Richard Walczak, BS, CCP a , Scott M. Palmer, MD b , R. Duane Davis, Jr, MD a , *

a Department of Surgery, Duke University Medical Center, Durham, North Carolina
b Department of Medicine, Duke University Medical Center, Durham, North Carolina

Accepted for publication April 26, 2005.

* Address correspondence to Dr Davis, Department of Surgery, Duke University Medical Center Box 2605, Durham, NC27710 (Email: davis053{at}mc.duke.edu).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Primary graft failure remains a significant source of mortality after lung transplantation. Extracorporeal membrane oxygenation (ECMO) provides treatment for affected recipients. We hypothesized that venovenous membrane oxygenation provides a safer alternative than venoarterial support for lung recipients suffering from primary graft failure.

METHODS: We conducted an analysis of 522 patients who underwent lung transplantation from April 1992 to July 2004. Twenty-three (4.5%) patients required membrane oxygenation secondary to primary graft failure unresponsive to conventional treatment. Of these recipients, 15 (65%) were treated with venoarterial, while 8 (35%) underwent venovenous membrane oxygenation.

RESULTS: Median days to initiation and duration of membrane oxygenation did not differ between groups. Eight of 15 patients (53%) from the venoarterial group were successfully weaned from life support, with one surviving greater than 45 days. This lone long-term survivor required retransplantation 4 days after initial transplant. In contrast, all venovenous patients were weaned from support, with 7 of 8 surviving greater than 30 days. The 30-day survival for venovenous recipients (88%) approximates that of all lung recipients at our center (94%, p = 0.42). Noted complications for ECMO patients included renal failure (n = 16), neurologic catastrophes (n = 8), sepsis (n = 5), and hemorrhage (n = 10). The venoarterial recipients suffered 30 of 39 total complications. Most of the complications for venovenous recipients involved renal failure, but by hospital discharge these patients demonstrated a mean creatinine of 0.9 mg/dL.

CONCLUSIONS: For lung recipients with primary graft failure, venovenous membrane oxygenation provides better outcomes, with fewer complications, than venoarterial membrane oxygenation.




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