Elbert E Heng, Aravind Krishnan, Stefan Elde, Alyssa Garrison, Moeed Fawad, Chawannuch Ruaengsri, Yasuhiro Shudo, Brandon A Guenthart, Y Joseph Woo, John W MacArthur
{"title":"体外膜肺氧合作为胸腔多器官移植的桥梁。","authors":"Elbert E Heng, Aravind Krishnan, Stefan Elde, Alyssa Garrison, Moeed Fawad, Chawannuch Ruaengsri, Yasuhiro Shudo, Brandon A Guenthart, Y Joseph Woo, John W MacArthur","doi":"10.1016/j.healun.2024.09.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood.</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other non-ECMO mechanical circulatory support, Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged.</p><p><strong>Results: </strong>Of 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p < 0.001). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between ECMO and non-ECMO patients (p = 0.82).</p><p><strong>Conclusions: </strong>ECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":""},"PeriodicalIF":6.4000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Extracorporeal membrane oxygenation as a bridge to thoracic multiorgan transplantation.\",\"authors\":\"Elbert E Heng, Aravind Krishnan, Stefan Elde, Alyssa Garrison, Moeed Fawad, Chawannuch Ruaengsri, Yasuhiro Shudo, Brandon A Guenthart, Y Joseph Woo, John W MacArthur\",\"doi\":\"10.1016/j.healun.2024.09.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood.</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other non-ECMO mechanical circulatory support, Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged.</p><p><strong>Results: </strong>Of 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p < 0.001). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between ECMO and non-ECMO patients (p = 0.82).</p><p><strong>Conclusions: </strong>ECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.</p>\",\"PeriodicalId\":15900,\"journal\":{\"name\":\"Journal of Heart and Lung Transplantation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.4000,\"publicationDate\":\"2024-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Heart and Lung Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.healun.2024.09.015\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Heart and Lung Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.healun.2024.09.015","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Extracorporeal membrane oxygenation as a bridge to thoracic multiorgan transplantation.
Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood.
Methods: The United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other non-ECMO mechanical circulatory support, Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged.
Results: Of 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p < 0.001). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between ECMO and non-ECMO patients (p = 0.82).
Conclusions: ECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.
期刊介绍:
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.