Background
We sought to describe trends in extracorporeal membrane oxygenation (ECMO) use, and
define the impact on PGD incidence and early mortality in lung transplantation.
Methods
Patients were enrolled from August 2011 to June 2018 at 10 transplant centers in the
multi-center Lung Transplant Outcomes Group prospective cohort study. PGD was defined
as Grade 3 at 48 or 72 hours, based on the 2016 PGD ISHLT guidelines. Logistic regression
and survival models were used to contrast between group effects for event (i.e., PGD
and Death) and time-to-event (i.e., death, extubation, discharge) outcomes respectively.
Both modeling frameworks accommodate the inclusion of potential confounders.
Results
A total of 1,528 subjects were enrolled with a 25.7% incidence of PGD. Annual PGD
incidence (14.3%-38.2%, p = .0002), median LAS (38.0-47.7 p = .009) and the use of ECMO salvage for PGD (5.7%-20.9%, p = .007) increased over the course of the study. PGD was associated with increased
1 year mortality (OR 1.7 [95% C.I. 1.2, 2.3], p = .0001). Bridging strategies were not associated with increased mortality compared
to non-bridged patients (p = .66); however, salvage ECMO for PGD was significantly associated with increased
mortality (OR 1.9 [1.3, 2.7], p = .0007). Restricted mean survival time comparison at 1-year demonstrated 84.1 days
lost in venoarterial salvaged recipients with PGD when compared to those without PGD
(ratio 1.3 [1.1, 1.5]) and 27.2 days for venovenous with PGD (ratio 1.1 [1.0, 1.4]).
Conclusions
PGD incidence continues to rise in modern transplant practice paralleled by significant
increases in recipient severity of illness. Bridging strategies have increased but
did not affect PGD incidence or mortality. PGD remains highly associated with mortality
and is increasingly treated with salvage ECMO.
KEYWORDS
Abbreviations:
PGD (Primary Graft Dysfunction), ISHLT (International Society of Heart and Lung Transplantation), ECMO (Extracorporeal Membrane Oxygenation), LAS (Lung Allocation Score), LTOG (Lung Transplant Outcomes Group), VV (Venovenous), VA (Venoarterial), RMST (Restricted Mean Survival Time), HFDs (Hospital-Free days), VFDs (Ventilator-free days)To read this article in full you will need to make a payment
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Published online: August 30, 2022
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