Pub Date : 2025-10-17DOI: 10.1016/j.healun.2025.07.033
Anna K. Reed MD, PhD , Olaf Mercier MD, PhD , Juergen Behr MD, PhD , Kavita Dave MD , Göran Dellgren MD, PhD , Sakhee Kotecha MD , Jasleen Kukreja MD, PhD , Caroline Landry CPC, MSc , Bronwyn Levvey PhD , Haifa Lyster PhD , Orla Morrissey MD, PhD , Siavosh Saatee MD , Melissa Sanchez DClinPsy , Marc Schecter MD , James Walsh PhD , Ashley Virginia Fritz DO , Theresa A. Gelzinis MD , Konrad Hoetzenecker MD, PhD , Sandra Lindstedt MD, PhD , Nandor Marczin MD, PhD , Archer Kilbourne Martin MD
The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 50 recommendations regarding preoperative considerations for ECLS in lung transplantation met consensus criteria. These recommendations focus on the criteria for preoperative ECLS as well as select multidisciplinary team management considerations throughout the entire preoperative phase.
{"title":"ISHLT Consensus Statement on the Perioperative use of ECLS in Lung Transplantation: Part I: Preoperative Considerations","authors":"Anna K. Reed MD, PhD , Olaf Mercier MD, PhD , Juergen Behr MD, PhD , Kavita Dave MD , Göran Dellgren MD, PhD , Sakhee Kotecha MD , Jasleen Kukreja MD, PhD , Caroline Landry CPC, MSc , Bronwyn Levvey PhD , Haifa Lyster PhD , Orla Morrissey MD, PhD , Siavosh Saatee MD , Melissa Sanchez DClinPsy , Marc Schecter MD , James Walsh PhD , Ashley Virginia Fritz DO , Theresa A. Gelzinis MD , Konrad Hoetzenecker MD, PhD , Sandra Lindstedt MD, PhD , Nandor Marczin MD, PhD , Archer Kilbourne Martin MD","doi":"10.1016/j.healun.2025.07.033","DOIUrl":"10.1016/j.healun.2025.07.033","url":null,"abstract":"<div><div>The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 50 recommendations regarding preoperative considerations for ECLS in lung transplantation met consensus criteria. These recommendations focus on the criteria for preoperative ECLS as well as select multidisciplinary team management considerations throughout the entire preoperative phase.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 1","pages":"Pages e1-e34"},"PeriodicalIF":6.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.healun.2025.10.003
Daniel Burkhoff MD, PhD
{"title":"Pressure-volume analysis in clinical practice: Looking to the past helps us see the future","authors":"Daniel Burkhoff MD, PhD","doi":"10.1016/j.healun.2025.10.003","DOIUrl":"10.1016/j.healun.2025.10.003","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 282-283"},"PeriodicalIF":6.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.healun.2025.10.010
Scott C. Silvestry MD
{"title":"The next frontier—realizing the promise of DCD heart transplantation","authors":"Scott C. Silvestry MD","doi":"10.1016/j.healun.2025.10.010","DOIUrl":"10.1016/j.healun.2025.10.010","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 196-198"},"PeriodicalIF":6.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.healun.2025.10.006
Edmund M. Lau MBBS, PhD , Christian Gerges
{"title":"Lung transplantation for chronic thromboembolic pulmonary hypertension (CTEPH): A treatment of last resort","authors":"Edmund M. Lau MBBS, PhD , Christian Gerges","doi":"10.1016/j.healun.2025.10.006","DOIUrl":"10.1016/j.healun.2025.10.006","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 260-261"},"PeriodicalIF":6.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.healun.2025.09.022
Naoki Tadokoro MD, PhD , Sho Takemoto MD , Mansoo Cho MS , Taylor Nordan MD , Michael M. Givertz MD , Tanujit Dey PhD , Mandeep R. Mehra MD, MSc , Akinobu Itoh MD PhD
Introduction
Simultaneous heart–kidney transplantation (SHKT) has become an effective option for patients with end-stage heart and kidney failure; however, the shortage of donors remains a significant challenge. Since 2019, hearts donated after circulatory death (DCD) have been approved and increasingly used, but their safety in the context of SHKT has not been thoroughly studied.
Methods
We conducted a retrospective cohort study using the United Network for Organ Sharing (UNOS) database from January 2019 to December 2024, identifying 1761 adults who were primary SHKT recipients. To adjust for baseline differences, we performed propensity score matching (2:1 nearest neighbor), resulting in 298 donation after brain death (DBD) and 149 DCD recipients. The endpoints assessed included 2-year overall survival, delayed graft function (DGF), and kidney graft survival.
Results
After matching, both heart and kidney out-of-body times remained significantly longer in the DCD group compared to the DBD group (p < 0.001). DGF was more common in the DCD group (36% vs 26%, p = 0.023). Two-year survival rates were 83.6% in the DCD group and 82.3% in the DBD group (p = 0.88). Robust Cox models showed no association between donor type and two-year mortality (Hazard Ratio: 0.78, 95% Confidence Interval: 0.43-1.44, p = 0.5) or kidney graft failure (HR: 0.61, 95% CI: 0.16-2.26, p = 0.5).
Conclusion
SHKT using DCD donor organs shows similar 2-year survival and graft outcomes compared to those using DBD donors, supporting the safe and effective use of DCD organs to expand the donor pool.
同步心肾移植（SHKT）已成为终末期心脏和肾衰竭患者的有效选择；然而，捐助者短缺仍然是一个重大挑战。自2019年以来，循环死亡（DCD）后捐赠的心脏已被批准并越来越多地使用，但其在SHKT背景下的安全性尚未得到彻底研究。方法：2019年1月至2024年12月，我们使用UNOS数据库进行了一项回顾性队列研究，确定了1761名原发性SHKT接受者。为了调整基线差异，我们进行了倾向评分匹配（2:1最近邻），导致298名脑死亡（DBD）后捐赠和149名DCD接受者。评估的终点包括2年总生存期、延迟移植功能（DGF）和肾移植生存期。结果匹配后，DCD组心脏和肾脏离体时间明显长于DBD组（p < 0.001）。DGF在DCD组中更为常见（36% vs. 26%, p = 0.023）。DCD组2年生存率为83.6%，DBD组为82.3% （p = 0.88）。稳健的Cox模型显示供体类型与两年死亡率（风险比：0.78,95%可信区间：0.43-1.44,p = 0.5）或肾移植衰竭（风险比：0.61,95% CI: 0.16-2.26, p = 0.5）之间无关联。结论使用DCD供体器官的shkt与使用DBD供体器官的shkt相比具有相似的2年生存率和移植结果，支持安全有效地使用DCD器官来扩大供体池。
{"title":"Outcomes of simultaneous heart–kidney transplantation using donation after circulatory death donors: A propensity-matched analysis from the UNOS registry","authors":"Naoki Tadokoro MD, PhD , Sho Takemoto MD , Mansoo Cho MS , Taylor Nordan MD , Michael M. Givertz MD , Tanujit Dey PhD , Mandeep R. Mehra MD, MSc , Akinobu Itoh MD PhD","doi":"10.1016/j.healun.2025.09.022","DOIUrl":"10.1016/j.healun.2025.09.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Simultaneous heart–kidney transplantation (SHKT) has become an effective option for patients with end-stage heart and kidney failure; however, the shortage of donors remains a significant challenge. Since 2019, hearts donated after circulatory death (DCD) have been approved and increasingly used, but their safety in the context of SHKT has not been thoroughly studied.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the United Network for Organ Sharing (UNOS) database from January 2019 to December 2024, identifying 1761 adults who were primary SHKT recipients. To adjust for baseline differences, we performed propensity score matching (2:1 nearest neighbor), resulting in 298 donation after brain death (DBD) and 149 DCD recipients. The endpoints assessed included 2-year overall survival, delayed graft function (DGF), and kidney graft survival.</div></div><div><h3>Results</h3><div>After matching, both heart and kidney out-of-body times remained significantly longer in the DCD group compared to the DBD group (<em>p</em> < 0.001). DGF was more common in the DCD group (36% vs 26%, <em>p</em> = 0.023). Two-year survival rates were 83.6% in the DCD group and 82.3% in the DBD group (<em>p</em> = 0.88). Robust Cox models showed no association between donor type and two-year mortality (Hazard Ratio: 0.78, 95% Confidence Interval: 0.43-1.44, <em>p</em> = 0.5) or kidney graft failure (HR: 0.61, 95% CI: 0.16-2.26, <em>p</em> = 0.5).</div></div><div><h3>Conclusion</h3><div>SHKT using DCD donor organs shows similar 2-year survival and graft outcomes compared to those using DBD donors, supporting the safe and effective use of DCD organs to expand the donor pool.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 204-211"},"PeriodicalIF":6.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.healun.2025.09.024
Wayne M. Tsuang MD, PhD , Megan L. Neely PhD , Lianne G. Singer MD , John A. Belperio MD , Marie Budev DO , Courtney W. Frankel PT, MS , Jerry Kirchner BS , Scott M. Palmer MD, MHS , John M. Reynolds MD , Jamie L. Todd MD, MHS , S. Sam Weigt MD, MS , Laurie D. Snyder MD, MHS
Background
Lung transplantation (LT) has been shown to improve lung function and quality of life (QoL). We sought to clarify if QoL improvements coincide with improvements in spirometry assessments in the first post-transplant year.
Methods
In the multicenter observational Clinical Trials in Organ Transplantation-20 study, LT recipients had longitudinal forced expiratory volume in 1 second (FEV1) and QoL measurements, specifically the St. George’s Respiratory Questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36), collected at 1, 3, 6, 9, and 12 months post-LT. We assessed whether best QoL scores occurred before, simultaneously, or after best FEV1.
Results
Of 803 recipients, 702 met the inclusion criteria. The best total SGRQ score occurred before best FEV1 in 16.0% of patients, simultaneously in 28.3%, and afterward in 55.7%. Similarly, the best SF-36 physical score occurred before best FEV1 in 18.7% of patients, simultaneously in 32.7%, and afterward in 48.6%. Single LTs, age >65 years, male sex, and diagnosis other than cystic lung disease were associated with a higher likelihood of achieving best QoL after best FEV1.
Conclusions
Both spirometry and multiple physical and social QoL domains improved over the first post-LT year, but these improvements did not necessarily occur simultaneously. Nearly half of patients reached their best respiratory-specific and physical QoL scores after best FEV1; however, timing varied by recipient characteristics. As the pace of post-LT recovery is multifactorial, our findings provide insights to patients and providers regarding anticipated post-transplant changes and highlight the importance of considering both spirometry and QoL measures.
{"title":"Timing of quality of life and lung function changes during the first year following lung transplantation: A multicenter prospective cohort study","authors":"Wayne M. Tsuang MD, PhD , Megan L. Neely PhD , Lianne G. Singer MD , John A. Belperio MD , Marie Budev DO , Courtney W. Frankel PT, MS , Jerry Kirchner BS , Scott M. Palmer MD, MHS , John M. Reynolds MD , Jamie L. Todd MD, MHS , S. Sam Weigt MD, MS , Laurie D. Snyder MD, MHS","doi":"10.1016/j.healun.2025.09.024","DOIUrl":"10.1016/j.healun.2025.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation (LT) has been shown to improve lung function and quality of life (QoL). We sought to clarify if QoL improvements coincide with improvements in spirometry assessments in the first post-transplant year.</div></div><div><h3>Methods</h3><div>In the multicenter observational Clinical Trials in Organ Transplantation-20 study, LT recipients had longitudinal forced expiratory volume in 1 second (FEV1) and QoL measurements, specifically the St. George’s Respiratory Questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36), collected at 1, 3, 6, 9, and 12 months post-LT. We assessed whether best QoL scores occurred before, simultaneously, or after best FEV1.</div></div><div><h3>Results</h3><div>Of 803 recipients, 702 met the inclusion criteria. The best total SGRQ score occurred before best FEV1 in 16.0% of patients, simultaneously in 28.3%, and afterward in 55.7%. Similarly, the best SF-36 physical score occurred before best FEV1 in 18.7% of patients, simultaneously in 32.7%, and afterward in 48.6%. Single LTs, age >65 years, male sex, and diagnosis other than cystic lung disease were associated with a higher likelihood of achieving best QoL after best FEV1.</div></div><div><h3>Conclusions</h3><div>Both spirometry and multiple physical and social QoL domains improved over the first post-LT year, but these improvements did not necessarily occur simultaneously. Nearly half of patients reached their best respiratory-specific and physical QoL scores after best FEV1; however, timing varied by recipient characteristics. As the pace of post-LT recovery is multifactorial, our findings provide insights to patients and providers regarding anticipated post-transplant changes and highlight the importance of considering both spirometry and QoL measures.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 3","pages":"Pages 430-439"},"PeriodicalIF":6.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1016/j.healun.2025.09.026
Andrei M. Darie , Atsuo Doi , Bronwyn J. Levvey , Helen Shingles , Shaun Yo , Trevor Williams , Gregory I. Snell
Introduction
Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary vascular disease amenable to multimodal therapy. Pulmonary endarterectomy (PEA) is the cornerstone of CTEPH treatment for operable patients. However, a significant proportion of patients present with inoperable disease or residual postoperative pulmonary hypertension. Lung transplantation (LTx) remains a lifesaving therapy for patients with end-stage right heart failure due to CTEPH.
Methods
In this case series we describe six cases of CTEPH undergoing LTx at the Alfred Hospital. Half of the patients included in this case series underwent PEA prior to LTx.
Results
The most frequent finding on explant histology was arterial muscular hypertrophy due to thrombotic arteriopathy. We present the pre-transplant hemodynamic features and discuss the long-term outcomes post-LTx and the surgical challenges that can arise in the context of prior cardiothoracic surgery.
Conclusions
LTx is a definitive, although rarely utilized therapy, underlining the growing expertise and advancements in specific multimodal therapy for CTEPH.
{"title":"Lung transplantation for chronic thromboembolic pulmonary hypertension—a case series","authors":"Andrei M. Darie , Atsuo Doi , Bronwyn J. Levvey , Helen Shingles , Shaun Yo , Trevor Williams , Gregory I. Snell","doi":"10.1016/j.healun.2025.09.026","DOIUrl":"10.1016/j.healun.2025.09.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary vascular disease amenable to multimodal therapy. Pulmonary endarterectomy (PEA) is the cornerstone of CTEPH treatment for operable patients. However, a significant proportion of patients present with inoperable disease or residual postoperative pulmonary hypertension. Lung transplantation (LTx) remains a lifesaving therapy for patients with end-stage right heart failure due to CTEPH.</div></div><div><h3>Methods</h3><div>In this case series we describe six cases of CTEPH undergoing LTx at the Alfred Hospital. Half of the patients included in this case series underwent PEA prior to LTx.</div></div><div><h3>Results</h3><div>The most frequent finding on explant histology was arterial muscular hypertrophy due to thrombotic arteriopathy. We present the pre-transplant hemodynamic features and discuss the long-term outcomes post-LTx and the surgical challenges that can arise in the context of prior cardiothoracic surgery.</div></div><div><h3>Conclusions</h3><div>LTx is a definitive, although rarely utilized therapy, underlining the growing expertise and advancements in specific multimodal therapy for CTEPH.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 253-259"},"PeriodicalIF":6.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.healun.2025.09.025
Ramiro Fernandez MD , Fabio Ius MD , Jose Euberto Mendez Reyes MD , Nunzio Davide de Manna MD , Andres Leon-Pena MD , Matthew Hartwig MD , Kamrouz Ghadimi MD , Nathaniel B. Langer MD , Asishana A. Osho MD , Mohammed Kashem MD , Yoshida Toyoda MD , Amir Emtiazjoo MD , Mindaugas Rackauskas MD , Laurens J. Ceulemans MD , Cedric Vanluyten MD , Stephen Huddleston MD, PhD , Subramaniam Kathirvel MD , Silvana Crowley Carrasco MD , Pablo G. Sanchez MD, PhD , Uma Ramamurthy PhD , Gabriel Loor MD
Background
Intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) is becoming the most common mode of extracorporeal life support (ECLS) in lung transplantation (LTx). We compared rates of primary graft dysfunction (PGD) and other perioperative outcomes in patients who underwent LTx using VA ECMO with either central or peripheral arterial cannulation.
Methods
We analyzed bilateral lung transplants using intraoperative VA ECMO which were entered into the multicenter international ECLS in LTx registry between 1/2016 and 8/2024. Our primary outcome included Grade 3 Primary Graft Dysfunction (PGD3) at 48–72 hours. Secondary outcomes included postoperative complications and survival.
Results
There were 501 transplants that met inclusion criteria: 315 in the central group and 186 in the peripheral group. The incidence of PGD3 at 48–72 hours was 26.3% in the central group and 30.1% in the peripheral group (p = 0.42). In the logistic regression analysis, central vs peripheral cannulation was not associated with increased risk of PGD3 (OR 1.64, 95% CI 0.657–4.209, p = 0.294). We found no difference between groups in other graft-related outcomes nor cannulation-related complications including stroke. In the Cox regression analysis, central vs peripheral cannulation was not associated with overall survival (HR 1.5, 95% CI 0.70–3.20, p = 0.298).
Conclusions
The choice of arterial cannulation strategy for intraoperative VA ECMO support did not impact the risk of PGD3, graft- or cannulation-related complications, nor mid-term survival. The decision regarding arterial cannulation site strategy should be tailored to meet patient and procedural needs.
背景术中静脉动脉体外膜氧合（VA ECMO）正在成为肺移植（LTx）中最常见的体外生命支持（ECLS）模式。我们比较了采用中央或外周动脉插管的VA ECMO进行LTx患者的原发性移植物功能障碍（PGD）率和其他围手术期结果。方法分析2016年1月至2024年8月间纳入LTx多中心国际ECLS登记的术中VA ECMO双侧肺移植病例。我们的主要结局包括48-72小时的3级原发性移植物功能障碍（PGD3）。次要结局包括术后并发症和生存率。结果符合纳入标准的移植501例：中心组315例，外周组186例。48 ~ 72小时PGD3的发生率中央组为26.3%，外周组为30.1% （P=0.42）。在logistic回归分析中，中心静脉插管与外周静脉插管与PGD3风险增加无关（OR 1.64, 95% CI 0.657 - 4.209， P=0.294）。我们发现两组之间在其他移植物相关结果和插管相关并发症（包括卒中）方面没有差异。在Cox回归分析中，中心插管与外周插管与总生存率无关（HR 1.5, 95% CI 0.70-3.20， P=0.298）。结论术中动脉插管策略的选择不影响PGD3、移植物或插管相关并发症的风险，也不影响中期生存。有关动脉插管位置策略的决定应根据患者和手术的需要进行调整。
{"title":"Outcomes of central versus peripheral arterial cannulation for intraoperative extracorporeal membrane oxygenation support in lung transplantation","authors":"Ramiro Fernandez MD , Fabio Ius MD , Jose Euberto Mendez Reyes MD , Nunzio Davide de Manna MD , Andres Leon-Pena MD , Matthew Hartwig MD , Kamrouz Ghadimi MD , Nathaniel B. Langer MD , Asishana A. Osho MD , Mohammed Kashem MD , Yoshida Toyoda MD , Amir Emtiazjoo MD , Mindaugas Rackauskas MD , Laurens J. Ceulemans MD , Cedric Vanluyten MD , Stephen Huddleston MD, PhD , Subramaniam Kathirvel MD , Silvana Crowley Carrasco MD , Pablo G. Sanchez MD, PhD , Uma Ramamurthy PhD , Gabriel Loor MD","doi":"10.1016/j.healun.2025.09.025","DOIUrl":"10.1016/j.healun.2025.09.025","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) is becoming the most common mode of extracorporeal life support (ECLS) in lung transplantation (LTx). We compared rates of primary graft dysfunction (PGD) and other perioperative outcomes in patients who underwent LTx using VA ECMO with either central or peripheral arterial cannulation.</div></div><div><h3>Methods</h3><div>We analyzed bilateral lung transplants using intraoperative VA ECMO which were entered into the multicenter international ECLS in LTx registry between 1/2016 and 8/2024. Our primary outcome included Grade 3 Primary Graft Dysfunction (PGD3) at 48–72 hours. Secondary outcomes included postoperative complications and survival.</div></div><div><h3>Results</h3><div>There were 501 transplants that met inclusion criteria: 315 in the central group and 186 in the peripheral group. The incidence of PGD3 at 48–72 hours was 26.3% in the central group and 30.1% in the peripheral group (<em>p</em> = 0.42). In the logistic regression analysis, central vs peripheral cannulation was not associated with increased risk of PGD3 (OR 1.64, 95% CI 0.657–4.209, <em>p</em> = 0.294). We found no difference between groups in other graft-related outcomes nor cannulation-related complications including stroke. In the Cox regression analysis, central vs peripheral cannulation was not associated with overall survival (HR 1.5, 95% CI 0.70–3.20, <em>p</em> = 0.298).</div></div><div><h3>Conclusions</h3><div>The choice of arterial cannulation strategy for intraoperative VA ECMO support did not impact the risk of PGD3, graft- or cannulation-related complications, nor mid-term survival. The decision regarding arterial cannulation site strategy should be tailored to meet patient and procedural needs.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"45 2","pages":"Pages 242-250"},"PeriodicalIF":6.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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