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J Thorac Cardiovasc Surg 2002;124:626-627
© 2002 The American Association for Thoracic Surgery

Brief Communications

Extracorporeal membrane oxygenation with nafamostat mesilate as an anticoagulant for massive pulmonary hemorrhage after living-donor lobar lung transplantation

Kazutoshi Kotani, MDa, Shingo Ichiba, MDb, Masanori Andou, MDa, Yoshifumi Sano, MDa, Hiroshi Date, MDa, Takeo Tedoriya, MDc, Keiji Goto, MDd, Nobuyoshi Shimizu, MDa Okayama, Japan

From the Departments of Oncology and Thoracic Surgery,a Emergency Medicine,b Cardiovascular Surgery,c and Anesthesiology and Resuscitology,d Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan.

Received for publication March 25, 2002. Accepted for publication April 16, 2002. Address for reprints: Kazutoshi Kotani, Department of Oncology and Thoracic Surgery, Graduate School of Medicine and Dentistry, Okayama University, 2-5-1 Shikata, Okayama 700-8558, Japan (E-mail address: kk77@f7.dion.ne.jp).

The first 20% of the full text of this article appears below.

Living-donor lung lobar transplantation has become an acceptable treatment for selected patients with end-stage pulmonary disease. A few cases of extracorporeal membrane oxygenation (ECMO) for acute severe respiratory failure after lung transplantation have been reported.Go Go 1-3 We present our experience with ECMO for acute respiratory failure resulting from pulmonary hemorrhage after living-donor lobar lung transplantation.

Clinical summary

On June 23, 2001, a 27-year-old woman with end-stage primary pulmonary hypertension underwent bilateral living-donor lobar transplantation with her father's right lower lobe and her brother's left lower lobe under cardiopulmonary bypass. Postoperative immunosuppression was a triple-drug therapy consisting of cyclosporine (INN ciclosporin), azathioprine, and prednisone. Two episodes of acute rejection required high-dose methylprednisolone intravenously. On postoperative day 15, severe hypoxia with a massive hemoptysis developed. The arterial oxygen saturation (Sao2) was 62% with 100% oxygen. Chest radiography revealed pulmonary hemorrhages in the right graft (Figure 1). Bronchoscopic examination demonstrated normal bronchial healing. She was placed on differential mechanical ventilation . . . [Full Text of this Article]






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