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• W2895442988 abstract "SESSION TITLE: Advances in the Evaluation of Lung Transplant Patients SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: An increase in high-acuity lung transplant (LTx) candidates and a shortage of available donor lungs frequently forces clinicians to consider using organs from extended-criteria donors (ECDs). We analyzed the effects of using ECDs versus standard-criteria donors (SCDs) in LTx candidates receiving extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation (hereafter ECMO BTT). METHODS: We queried the database of the United Network for Organ Sharing to analyze data of patients who underwent LTx between January 1, 2010 and December 31, 2016. ECDs were identified as donors who had one or more of the following characteristics: age 65 years or older, smoking history of 20 pack-years or more, diagnosis of diabetes mellitus, or African American race. All other donors were considered SCDs. The Wilcoxon Rank Sum was used to analyze continuous variables; the chi-square test and the Fisher exact test were used to compare categorical variables. Multiple Cox regression was implemented to ascertain the risk of 1-year mortality in recipients of ECD lungs and ECMO BTT patients. RESULTS: Of the 12,152 LTx recipients returned in our search, 290 (2.39%) had received ECMO BTT. ECMO BTT patients had worse 30-day (p<0.001) and 1-year survival (p=0.001) after LTx than patients who did not receive ECMO BTT. ECMO BTT patients also had higher incidence of perioperative complications, including acute cellular rejection (p=0.001), stroke (p=0.001), and ECMO salvage for post-LTx primary graft dysfunction (p <0.001). Of the 290 ECMO BTT patients, 100 (34.48%) received lungs from ECDs; 187 (64.48%) received lungs from SCDs. In patients that required ECMO BTT, the mortality risk of patients with ECD lungs was 2 times higher than it was in recipients of SCD lungs (HR [95% CI] =2.07 [1.11, 3.87]; p=0.02). Among patients who did not require ECMO BTT, patients with ECD lungs had lower 1-y survival than those who received SCD lungs (75% vs 85%, p=0.04). Furthermore, the risk of death was two times higher (HR [95% CI] =2.01 [1.27, 3.18]; p=0.003) for patients who received ECD lungs and required ECMO BTT compared to patients who received ECD lungs but did not require ECMO BTT. Due to the small sample size, no significant differences were noted in perioperative complications between recipients of SCD and ECD lungs when those patients also required ECMO BTT. CONCLUSIONS: ECMO BTT is associated with increased risk of perioperative complications and reduced survival after LTx. Furthermore, the risk of death is even greater in ECMO BTT patients who receive ECD lungs than in ECMO BTT patients who receive SCD lungs. CLINICAL IMPLICATIONS: ECMO BTT is associated with increased risk of perioperative complications and reduced survival after LTx. Furthermore, the risk of death is even greater in ECMO BTT patients who receive ECD lungs than in ECMO BTT patients who receive SCD lungs. DISCLOSURES: no disclosure on file for Sreeja Biswas Roy; grant/research support relationship with Ethicon Endo-Surgery Please note: $1001 - $5000 Added 03/19/2018 by Ross Bremner, source=Web Response, value=Grant/Research Support No relevant relationships by Shaimaa Elnahas, source=Web Response No relevant relationships by Samad Hashimi, source=Web Response educational grant relationship with Ethicon Please note: $1-$1000 Added 03/05/2018 by JASMINE HUANG, source=Web Response, value=to our program's research fund No relevant relationships by Paul Kang, source=Web Response No relevant relationships by Ashraf Omar, source=Web Response Scientific Medical Advisor relationship with Transmedics Inc Please note: $20001 - $100000 Added 03/19/2018 by Michael Smith, source=Web Response, value=Grant/Research Support Course Instructor relationship with Ethicon Endosurgery Please note: $5001 - $20000 Added 03/19/2018 by Michael Smith, source=Web Response, value=Grant/Research Support no disclosure on file for Rajat Walia" @default.
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• W2895442988 date "2018-10-01" @default.
• W2895442988 modified "2023-09-26" @default.
• W2895442988 title "EXTRACORPOREAL MEMBRANE OXYGENATION AS A BRIDGE TO LUNG TRANSPLANTATION INCREASES THE RISK OF MORBIDITY AND MORTALITY AFTER TRANSPLANT, ESPECIALLY FOR RECIPIENTS OF EXTENDED-CRITERIA DONOR LUNGS" @default.
• W2895442988 doi "https://doi.org/10.1016/j.chest.2018.08.1005" @default.
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