Does reperfusion injury still cause significant mortality after lung transplantation?

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

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

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] × [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 χ2, 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.

Original languageEnglish (US)
Pages (from-to)688-694
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2009

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Lung Transplantation
Reperfusion Injury
Mortality
Extracorporeal Membrane Oxygenation
Survival
Oxygen
Partial Pressure
Students
Transplants

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Does reperfusion injury still cause significant mortality after lung transplantation? / Ailawadi, Gorav; Lau, Christine L.; Smith, Philip W.; Swenson, Brian R.; Hennessy, Sara A.; Kuhn, Courtney J.; Fedoruk, Lynn M.; Kozower, Benjamin D.; Kron, Irving L.; Jones, David R.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 3, 01.03.2009, p. 688-694.

Research output: Contribution to journalArticle

Ailawadi, G, Lau, CL, Smith, PW, Swenson, BR, Hennessy, SA, Kuhn, CJ, Fedoruk, LM, Kozower, BD, Kron, IL & Jones, DR 2009, 'Does reperfusion injury still cause significant mortality after lung transplantation?', Journal of Thoracic and Cardiovascular Surgery, vol. 137, no. 3, pp. 688-694. https://doi.org/10.1016/j.jtcvs.2008.11.007
Ailawadi, Gorav ; Lau, Christine L. ; Smith, Philip W. ; Swenson, Brian R. ; Hennessy, Sara A. ; Kuhn, Courtney J. ; Fedoruk, Lynn M. ; Kozower, Benjamin D. ; Kron, Irving L. ; Jones, David R. / Does reperfusion injury still cause significant mortality after lung transplantation?. In: Journal of Thoracic and Cardiovascular Surgery. 2009 ; Vol. 137, No. 3. pp. 688-694.
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abstract = "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] × [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 χ2, 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.",
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AU - Ailawadi, Gorav

AU - Lau, Christine L.

AU - Smith, Philip W.

AU - Swenson, Brian R.

AU - Hennessy, Sara A.

AU - Kuhn, Courtney J.

AU - Fedoruk, Lynn M.

AU - Kozower, Benjamin D.

AU - Kron, Irving L.

AU - Jones, David R.

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N2 - 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] × [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 χ2, 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.

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