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Gorav Ailawadi
Christine L. Lau
Philip W. Smith
Lynn M. Fedoruk
Benjamin D. Kozower
Irving L. Kron
David R. Jones
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Right arrow Lung - transplantation
Right arrow Extracorporeal circulation

J Thorac Cardiovasc Surg 2009;137:688-694
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Does reperfusion injury still cause significant mortality after lung transplantation?

Gorav Ailawadi, MD, Christine L. Lau, MD*, Philip W. Smith, MD, Brian R. Swenson, MD, MS, Sara A. Hennessy, MD, Courtney J. Kuhn, Lynn M. Fedoruk, MD, Benjamin D. Kozower, MD, Irving L. Kron, MD, David R. Jones, MD

Department of Surgery, University of Virginia, Charlottesville, Va

Received for publication May 9, 2008; revisions received August 21, 2008; accepted for publication November 6, 2008.

* Address for reprints: Christine L. Lau, MD, Department of Surgery, University of Virginia, PO Box 800679, Charlottesville, VA 22908-0679. (Email: cll2y{at}virginia.edu).

Objectives: Severe reperfusion injury after lung transplantation has mortality rates approaching 40%. The purpose of this investigation was to identify whether our improved 1-year survival after lung transplantation is related to a change in reperfusion injury.

Methods: We reported in March 2000 that early institution of extracorporeal membrane oxygenation can improve lung transplantation survival. The records of consecutive lung transplant recipients from 1990 to March 2000 (early era, n = 136) were compared with those of recipients from March 2000 to August 2006 (current era, n = 155). Reperfusion injury was defined by an oxygenation index of greater than 7 (where oxygenation index = [Percentage inspired oxygen] x [Mean airway pressure]/[Partial pressure of oxygen]). Risk factors for reperfusion injury, treatment of reperfusion injury, and 30-day mortality were compared between eras by using {chi}2, Fisher's, or Student's t tests where appropriate.

Results: Although the incidence of reperfusion injury did not change between the eras, 30-day mortality after lung transplantation improved from 11.8% in the early era to 3.9% in the current era (P = .003). In patients without reperfusion injury, mortality was low in both eras. Patients with reperfusion injury had less severe reperfusion injury (P = .01) and less mortality in the current era (11.4% vs 38.2%, P = .01). Primary pulmonary hypertension was more common in the early era (10% [14/136] vs 3.2% [5/155], P = .02). Graft ischemic time increased from 223.3 ± 78.5 to 286.32 ± 88.3 minutes in the current era (P = .0001). The mortality of patients with reperfusion injury requiring extracorporeal membrane oxygenation improved in the current era (80.0% [8/10] vs 25.0% [3/12], P = .01).

Conclusion: Improved early survival after lung transplantation is due to less severe reperfusion injury, as well as improvements in survival with extracorporeal membrane oxygenation.

Abbreviations and Acronyms ATGAM = antithymocyte globulin; CMV = cytomegalovirus; COPD = chronic obstructive pulmonary disease; ECMO = extracorporeal membrane oxygenation; FIO 2 = fraction of inspired oxygen; ISHLT = International Society for Heart and Lung Transplantation; LTX = lung transplantation; NO = nitric oxide; OI = oxygenation index; OPO = organ procurement organization; P/F = PaO 2/FIO 2 ; PGD = primary graft dysfunction; PPH = primary pulmonary hypertension; RI = reperfusion injury




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