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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS42. Extracorporeal Membrane Oxygenation in Pediatric LungTransplantationVarun Puri, 1† Deirdre Epstein, 1 Steven C. Raithal, 1 Sanjiv K. Gandhi, 1*Stuart C. Sweet, 2 Albert Faro, 2 Charles B. Huddleston 1*1. Division of Cardiothoracic Surgery, Washington University, St. Louis, MO, USA;2. Department of Pediatrics, Washington University, St. Louis, St. Louis, MO, USAInvited Discussant: Victor MorellOBJECTIVE: To study Extracorporeal Membrane Oxygenation (ECMO) supportin the perioperative period in pediatric lung transplantation (LTx).METHODS: Review of an institutional database of pediatric LTx from 1990 to 2008.RESULTS: Three hundred forty-two patients underwent LTx over the study period.Thirty-three of 342 (9.6%) patients required ECMO support in the perioperative period.Fifteen patients (mean age 2.7 ± 4.4 years) required 16 ECMO runs in the pretransplantperiod (PRE). Their diagnoses were; Pulmonary hypertension n = 4, Surfactantdeficiency n = 3, Graft failure n = 3, others n = 4. The indications for ECMO wererespiratory failure 8/16 (50%), severe pulmonary hypertension 5/16 (31%) and cardiopulmonarycollapse 3/16 (19%). Vascular access was V-A (veno-arterial) (16/16,100%) with neck vessels the preferred cannulation site (14/16, 87%). Mean durationof ECMO support was 226 ± 159 hours. All patients survived through LTx and 4/15(27%) required ECMO support postoperatively. The mean time to LTx from institutionof ECMO was 516 ± 631 hours and 6/15 (40%) patients were weaned off ECMOprior to LTx. Six of 15 (40%) PRE patients survived to hospital discharge. Complications(sepsis, reexploration and massive bleeding) were seen in 10/16 (63%)ECMO runs. Survival to discharge was higher in patients weaned off ECMO priorto LTx (4/6, 66%) than patients on ECMO going into LTx (2/9, 22%). All PREpatients requiring ECMO support postoperatively, or undergoing redo LTx died.Twenty-two patients (mean age 8.9 ± 7.5 years) underwent 24 ECMO runs afterLtX (POST). Their diagnoses were; Cystic fibrosis n = 6, Pulmonary hypertension n= 5, Obliterative bronchiolitis n = 4 and others n = 7. The indications for ECMOsupport were; Primary graft dysfunction 16/24 (67%), pneumonia 4/24 (16%) andothers 4/24 (16%). The mean time between LTx and institution of ECMO was 222± 312 hours. Access was predominantly V-A (23/24, 96%) and mean duration ofECMO support was 158 ± 125 hours. Four of 22 (18%) patients survived to hospitaldischarge (median survival 5.8 years). Amongst the non-survivors, the causes ofdeath were intractable respiratory failure (13/18, 72%) and infectious complications(3/18, 17%). No specific risk factors were identified to predict poor outcomesin the POST group.CONCLUSION: The need for perioperative ECMO support is associated with significantmorbidity and mortality in pediatric LTx. A subset of patients who can beweaned off ECMO in the preoperative setting have greater likelihood of survival.* AATS Member† Resident Traveling Fellowship 2008174
AMERICAN ASSOCIATION FOR THORACIC SURGERY43. Lung Transplantation Using Donation After Cardiac DeathDonors: Long-Term Follow-Up in a Single CenterSatoru Osaki, 1 James D. Maloney, 1 Keith C. Meyer, 2 Richard D. Cornwell, 2Holly K. Thomas, 1 Niloo M. Edwards, 1 Nilto C. De Oliveira 11. Division of Cardiothoracic Surgery, Department of Surgery, University of WisconsinSchool of Medicine and Public Health, Madison, WI, USA; 2. Section of Allergy,Pulmonary, and Critical Care Medicine, Department of Medicine, University ofWisconsin School of Medicine and Public Health, Madison, WI, USAInvited Discussant: Dirk E.M. Van RaemdonckOBJECTIVE: The shortage of donor organs is the most critical problem in solidorgan transplantation. In an attempt to solve this, donation after cardiac death(DCD) donors have been proposed as an additional source of donor organs.Although short-term outcomes after DCD lung transplantation (LTx) have beendescribed, there are no long-term survival reports and the susceptibility to injuryand post-transplant reliability of DCD lung allograft are unclear. This study examinesour institutional experience in DCD LTx after 1993.METHODS: Between 1993 and 2007, 365 consecutive patients underwent LTx at asingle center. Among these patients, 17 (4.7%) patients had LTx from DCD donors.Patients transplanted from DCD donors (DCD group, n = 17) were compared topatients transplanted from brain dead donors (BDD group, n = 348).TUESDAYAfternoonRESULTS: Patient demographics, donor age, and cold ischemic time did not differbetween the groups: recipient age (DCD: 49 ± 12 yrs vs BDD: 49 ± 12 yrs, p = 0.89),distribution of diagnosis (% of chronic obstructive lung disease; 47% vs 38%, p =0.97), donor age (28 ± 13 yrs vs 31 ± 14 yrs, p = 0.29), bilateral LTx procedure (40%vs 41%, p = 0.55), and cold ischemic time (363 ± 145 min vs 381 ± 106 min, p = 0.70).Warm ischemic time (from withdrawal of support to reperfusion of organs) was33 ± 17 min (range: 18–89 min, 10 DCDs < 30 min). The survival rates in the DCDgroup at 1, 2 and 5 yrs were 88%, 88% and 80%, respectively (median follow-up,1075 days; range, 1–3210). These survival rates were not different from those of theBDD group (Log-rank test; p = 0.81, Figure). In the DCD group, 5 patients died.Causes of death were: small bowel infarction and multiple system organ failure(MSOF) on day 1, bronchiolitis obliterans (BOS) on day 305, metastatic colon cancerafter 2.91 yrs, non-small cell cancer on native lung after 5.59 yrs, and MSOFafter 8.79 yrs. 3 DCD patients required redo LTx (2 for BOS on day 91 and 8.55 yrsand 1 for bronchial dehiscence on day 22).175
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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