- Email: [email protected]
14
S48
Abstracts
The Journal of Heart and Lung Transplantation February 2006
pulmonary function, perhaps reflecting the contribution of the nativelung or the death of the most severely affected SLT patients. PGD Grade Stratifies Pulmonary Function After Bilateral Lung Transplantation
PGD Grade 1 PGD Grade 2 PGD Grade 3
1 Year FEV1
3 Year FEV1
5 Year FEV1
n ⴝ 103
n ⴝ 68
n ⴝ 43
92 ⫾ 4.2 87 ⫾ 4.5 71 ⫾ 4.5 p ⫽ 0.002
99 ⫾ 5.6 82 ⫾ 6.1 70 ⫾ 5.6 p ⫽ 0.002
97 ⫾ 6.7 74 ⫾ 7.5 58 ⫾ 7.2 p ⫽ 0.001
FEV1 reported as percent of predicted value ⫾ standard error.
12 EARLY ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION) IMPROVES SURVIVAL AFTER SEVERE PRIMARY GRAFT DYSFUNCTION (PGD) IN LUNG TRANSPLANTATION C.H. Wigfield,1,2 J.D. Lindsey,1,2 T.G. Steffens,1 N.M. Edwards,1 R.B. Love,1,2 1Cardiothoracic Surgery, University of Wisconsin Hospitals, Madison, WI; 2Lung Injury Research Group, University of Wisconsin Hospitals, Madison, WI Background: Mortality for severe primary graft dysfunction (PGD) after lung transplantation (LTx) remains high. Management is controversial and ECMO has been used infrequently for recovery from acute lung injury (ALI) in this setting. We provide a retrospective analysis with improved outcomes. Methods: A retrospective analysis of the database of all LTx patients between 7/1991 and 11/2004 was performed. 22 patients sustained severe PGD following LTx with subsequent ECMO for progressive hypoxemia, high ventilatory pressure requirements, administration of Nitric Oxide (NO), failing venous saturation (SVO2) and appropriate vasopressors. ECMO indications, recovery and complications were assessed. We analyzed 30 day, 1 and 3 year mortality. The incidence of multi-organ failure (MOF) and development of Bronchiolitis Obliterans Syndrome (BOS) was reviewed. Results: A total of 286 LTx and 11 Heart/Lung Transplants (HLTx) were performed during the study period with 97.5%, 88.6%, 73.8% survival at 30 day, 1 year and 3 years, respectively. During this same period 22 patients (7.9%) experienced severe allograft dysfunction leading to ECMO support. 10 patients received single, 8 double, and 1 single lung/kidney transplant, and 1 HLTx. 30 day, 1 year and 3 year survival of LTx recipients with ECMO support post-operatively were 74.6%, 54%, and 36%, respectively. BOS was diagnosed in 30% of all LTx at 3 years. MOF was the predominant cause of death (52.6%) despite improved oxygenation in the majority of patients with lethal PGF. Conclusions: Our data suggest that in addition to prolonged ventilation and pharmacological support, ECMO should be considered as a bridge to recovery from primary graft dysfunction in lung transplantation. Specific complications during ECMO support can be managed with a low incidence of long-term morbidities. Acute lung injury resulting in early institution of ECMO may lead to diminished mortality in these patients. 13 EARLY TREND ANALYSIS AFTER SEVERE PRIMARY GRAFT DYSFUNCTION FOLLOWING LUNG TRANSPLANTATION M.E. Prekker,1 C.S. Herrington,1 P.S. Dahlberg,1 1Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, MN Background: Several primary graft dysfunction (PGD) scoring systems based on measurement of the patient’s worst arterial oxygen
concentration to fraction of inspired oxygen (P/F) ratio in the first 48 –72 hours stratify patients into groups with different rates of perioperative death. Scores based on earlier measurements (ICU arrival/T0) can identify patients who might benefit from effective intervention, but they are less sensitive and specific for the endpoint. We hypothesized that early trend analysis of the P/F ratio would improve the predictive power of the T0 score. Methods: Retrospective review of 417 patients undergoing LTX at one institution from 1992 through June 2005. P/F ratios were measured at regular intervals in the first 72 hours post-transplant. Severe PGD was defined as a P/F ratio ⬍ 200. The P/F trend was calculated as the difference in the P/F ratio from T0 to 12 hours(T12). Results: Severe PGD was present in 97/417 (23.3%) of LTX patients at ICU arrival (T0). The overall 90-day death rate of this group was 17/97 (17.5%). Patients with a worsening trend in their P/F ratio (P/F change ⱕ 0) by T12 had a dramatically higher 90-day mortality rate and longer ICU stay compared with patients with an improving trend (Table 1). Medium-term survival of patients in the group with a worsening P/F trend was also poorer compared to the group with an improving trend (5 year survival: P/F change ⬎0, 44%, vs. P/F change ⬍0, 33%, p ⫽ 0.03 Log Rank). Conclusions: In LTX patients experiencing severe PGD upon ICU arrival, early trends in the P/F ratio identify subgroups with dramatically better and poorer outcomes compared to the overall group. Effective interventions guided by the P/F trend should improve survival following LTX. Outcomes After LTX In Patients With Severe PGD at T0, Grouped by P/F Change by T12 P/F change
90-day deaths
Median ICU days
⬎ 100 (n ⫽ 17) 1–100 (n ⫽ 26) ⱕ 0 (n ⫽ 54)
0 (0%) 2 (8%) 15 (28%)*
4 3 12*
*p ⬍ 0.001 compared to patients with P/F change ⬎ 0.
14 DYNAMIC CHANGES IN PLASMA ICAM AND VWF LEVELS IN PRIMARY GRAFT DYSFUNCTION AFTER LUNG TRANSPLANTATION J.D. Christie,1 S. Kawut,3 J. DeAndrade,2 A. Milstone,4 A. Weinacker,5 J. Orens,6 V. Lama,7 E. Demissie,1 S. Bellamy,1 L. Ware,4 the Lung Transplant Outcomes Group, 1University of Pennsylvania School of Medicine, Philadelphia, PA; 2University of Alabama, Birmingham, AL; 3Columbia University, New York, NY; 4 Vanderbilt University, Nashville, TN; 5Stanford University, Stanford, CA; 6Johns Hopkins University, Baltimore, MD; 7 University of Michigan, Ann Arbor, MI Background: The role of upregulation in intracellular adhesion molecule (ICAM) in the pathogenesis of experimental lung injury has been recognized, and Von Willebrand Factor antigen (VWF) has been suggested as a marker of acute lung injury. We hypothesized that plasma levels of ICAM and VWF levels would be elevated in PGD after lung transplant. Methods: Plasma levels of ICAM and VWF were measured at 6, 24, 48, and 72 hours following reperfusion in 128 lung transplant patients enrolled between 6/03 and 11/04 in the Lung Transplant Outcomes Group Cohort Study (including Penn, Columbia, Stanford, Vanderbilt, Michigan, and UAB). The primary outcome was PGD ISHLT Grade 3 (PaO2/FiO2⬍200 with alveolar infiltrates), at 72 hours postoperatively (T72). All plasma and clinical data were collected prospectively. ICAM and VWF were measured by ELISA and biomarker profiles were evaluated in multivariable analyses using generalized estimating equations (GEE).
The Journal of Heart and Lung Transplantation Volume 25, Number 2S
Results: Plasma ICAM levels were elevated within hours of reperfusion in those with Grade3 T72 PGD, and remained higher during the three day period. In contrast, VWF seemed to rise later in the course of lung injury. The mean plasma ICAM level measured at 6 hours following reperfusion in those with Grade 3 PGD at T72 was 338 ⫹/⫺ 155 vs. 255 ⫹/⫺ 122 in those with Grade 0, 1, and 2 PGD (p⫽0.014). The GEE contrast estimate for the association of ICAM with Grade 3 PGD was 107.5 (95% CI 38.7, 176.3), p⫽0.0022, indicating that on average the ICAM level was over 100 mg/dL higher in Grade 3 PGD than other grades over the 72 hour time course. This finding was unaltered by adjustment for recipient diagnosis, age, race, sex, donor age, sex, race, ischemic time, or use of cardiopulmonary bypass. Early VWF levels were not significantly different between the groups (p⫽0.27), and the VWF GEE did not show a significant difference over 72 hours (p⫽0.66). Conclusion: Elevated plasma ICAM levels are associated with prolonged severe acute lung injury following lung transplantation. 15 SERUM VEGF LEVELS IN LUNG TRANSPLANT RECIPIENTS PREDICT PRIMARY GRAFT DYSFUNCTION S. Aharinejad,1,2 K. Krenn,2 S. Taghavi,1 W. Klepetko,1 1 Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria; 2Laboratory for Cardiovascular Research, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria Background: Primary graft dysfunction (PGD) due to ischemiareperfusion injury is a severe complication in lung transplantation (LTX). Therapeutic strategies are limited and there are no standardized pre-operative markers to predict PGD. Vascular endothelial growth factor (VEGF) is a key regulator of vascular permeability. Methods: Pre-operative VEGF serum levels were assessed in 80 consecutive patients undergoing LTX by ELISA. Diseases leading to LTX were: COPD (n⫽30), cystic fibrosis (n⫽16), idiopathic pulmonary fibrosis (n⫽12), primary pulmonary hypertension (n⫽6), and others (n⫽16). The ischemia time of the grafts was 5 h ⫾ 65 min and the PaO2/FiO2 ratio of the donors was ⬎ 300. PGD was diagnosed and scored by characteristic changes in chest radiographs and PaO2/FiO2 ratio according to the guidelines of the International Society for Heart and Lung Transplantation, grading PGD from 0 to 3 within 72 hours after LTX (0 ⫽ none; 1 ⫽ only radiographic evidence; 2 ⫽ moderate, PaO2/FiO2 ratio 200 –300; 3 ⫽ severe, PaO2/FiO2 ratio ⬍ 200 or ECMO necessary). Results: Grade 3 PGD occurred in 15%, grade 2 in 23%, grade 1 in 43% and grade 0 in 19% of the patients. The pre-operative VEGF serum levels were significantly higher in patients with PGD grade 2 and 3 versus those without clinically relevant PGD (grade 0 and 1) following LTX (p⫽0.0007). Pre-operative recipient VEGF serum levels significantly predicted PGD in receiver operating characteristic curve analysis (p⫽0.0002, AUC⫽0.755, CI⫽1.001–1.003). Conclusions: Pre-operative serum VEGF levels in lung transplant patients could identify those at risk for PGD, and thus enable early intervention.
Abstracts
S49
Background: Lung transplantation can cause surfactant dysfunction that may be a contributing factor for primary graft dysfunction and graft failure. Aim: To study the effect of exogenous surfactant on post lung transplantation oxygenation and recovery. Study Design: Prospective open randomized controlled study. Patients: 22 subjects (14 men and 8 women), 20 underwent single lung transplantation due to Fibrosis (10), COPD (8), and retransplant for BOS (2), and 2 with double lung transplantation due to CF and bronchiectasis. Methods: In 18 patients 2 lungs were transplanted from the same donor for 2 recipients one patient was treated with surfactant while the other served as control. Otherwise surfactant was given in every other case. 20mg phospholipids/kg bovine surfactant was administered via a fiberoptic bronchoscope after establishment of bronchial anastomosis and ventilation of the transplanted lung. Results: Patients who received surfactant had better post operative oxygenation (mean PaO2/FIO2 430 vs. 290mmHg p⫽0.03), they were extubated earlier (mean 14.5 vs. 22.4 hours). There was a tendency towards shorter ICU stay among treated patients (2.4 vs. 7.7 days p⫽NS). One month vital capacity in was better in surfactant treated patients (58.6% vs. 48 % p⫽0.05) and FEV1 (57.3% vs. 48% p⫽NS). One control patient was reintubated after 3 days. One treated patient died from severe rejection after 61 days. Conclusions: Surfactant instillation during lung transplantation improves oxygenation, shortens intubation time and enhances early post transplantation recovery. Further larger studies are needed to asses the routine use of surfactant for the prevention of graft dysfunction and improvement of transplant outcome.
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HEART TRANSPLANTATION IN CHILDREN WITH MARKEDLY ELEVATED PULMONARY VASCULAR RESISTANCE G. Ofori-Amanfo,1 D. Hsu,1 J.M. Lamour,1 S. Mital,1 M.L. O’Byrne,1 A.J. Smerling,1 J.M. Chen,1 R. Mosca,1 L.J. Addonizio,1 1Pediatrics, Columbia University Medical Center, New York, NY
THE USE OF SURFACTANT IN LUNG TRANSPLANTATION: A RANDOMIZED CONTROL PILOT STUDY A. Amital,1 D. Shitrit,1 Y. Raviv,1 D. Bendayan,1 A. Kogan,2 G. Sahar,2 M. Saute,2 I. Bakal,1 M.R. Kramer,1 1Pulmonary Institute, Rabin Medical Center-Belinson Campus, Petach Tikva, Israel; 2Cardiothoracic Department, Rabin Medical CenterBelinson Campus, Petach Tikva, Israel
Markedly elevated pulmonary vascular resistance (PVRI) is associated with an increased risk of right ventricular failure (RVF) post-transplantation (Tx) and increased morbidity and mortality. A PVRI ⱖ6IU is a contraindication to heart Tx in many centers and pts are referred for higher risk heart-lung Tx. Method: We reviewed our 21-year experience of heart Tx in children with a PVRI ⱖ6IU. Among 263 children and young adults transplanted
Abstracts
The Journal of Heart and Lung Transplantation February 2006
pulmonary function, perhaps reflecting the contribution of the nativelung or the death of the most severely affected SLT patients. PGD Grade Stratifies Pulmonary Function After Bilateral Lung Transplantation
PGD Grade 1 PGD Grade 2 PGD Grade 3
1 Year FEV1
3 Year FEV1
5 Year FEV1
n ⴝ 103
n ⴝ 68
n ⴝ 43
92 ⫾ 4.2 87 ⫾ 4.5 71 ⫾ 4.5 p ⫽ 0.002
99 ⫾ 5.6 82 ⫾ 6.1 70 ⫾ 5.6 p ⫽ 0.002
97 ⫾ 6.7 74 ⫾ 7.5 58 ⫾ 7.2 p ⫽ 0.001
FEV1 reported as percent of predicted value ⫾ standard error.
12 EARLY ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION) IMPROVES SURVIVAL AFTER SEVERE PRIMARY GRAFT DYSFUNCTION (PGD) IN LUNG TRANSPLANTATION C.H. Wigfield,1,2 J.D. Lindsey,1,2 T.G. Steffens,1 N.M. Edwards,1 R.B. Love,1,2 1Cardiothoracic Surgery, University of Wisconsin Hospitals, Madison, WI; 2Lung Injury Research Group, University of Wisconsin Hospitals, Madison, WI Background: Mortality for severe primary graft dysfunction (PGD) after lung transplantation (LTx) remains high. Management is controversial and ECMO has been used infrequently for recovery from acute lung injury (ALI) in this setting. We provide a retrospective analysis with improved outcomes. Methods: A retrospective analysis of the database of all LTx patients between 7/1991 and 11/2004 was performed. 22 patients sustained severe PGD following LTx with subsequent ECMO for progressive hypoxemia, high ventilatory pressure requirements, administration of Nitric Oxide (NO), failing venous saturation (SVO2) and appropriate vasopressors. ECMO indications, recovery and complications were assessed. We analyzed 30 day, 1 and 3 year mortality. The incidence of multi-organ failure (MOF) and development of Bronchiolitis Obliterans Syndrome (BOS) was reviewed. Results: A total of 286 LTx and 11 Heart/Lung Transplants (HLTx) were performed during the study period with 97.5%, 88.6%, 73.8% survival at 30 day, 1 year and 3 years, respectively. During this same period 22 patients (7.9%) experienced severe allograft dysfunction leading to ECMO support. 10 patients received single, 8 double, and 1 single lung/kidney transplant, and 1 HLTx. 30 day, 1 year and 3 year survival of LTx recipients with ECMO support post-operatively were 74.6%, 54%, and 36%, respectively. BOS was diagnosed in 30% of all LTx at 3 years. MOF was the predominant cause of death (52.6%) despite improved oxygenation in the majority of patients with lethal PGF. Conclusions: Our data suggest that in addition to prolonged ventilation and pharmacological support, ECMO should be considered as a bridge to recovery from primary graft dysfunction in lung transplantation. Specific complications during ECMO support can be managed with a low incidence of long-term morbidities. Acute lung injury resulting in early institution of ECMO may lead to diminished mortality in these patients. 13 EARLY TREND ANALYSIS AFTER SEVERE PRIMARY GRAFT DYSFUNCTION FOLLOWING LUNG TRANSPLANTATION M.E. Prekker,1 C.S. Herrington,1 P.S. Dahlberg,1 1Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, MN Background: Several primary graft dysfunction (PGD) scoring systems based on measurement of the patient’s worst arterial oxygen
concentration to fraction of inspired oxygen (P/F) ratio in the first 48 –72 hours stratify patients into groups with different rates of perioperative death. Scores based on earlier measurements (ICU arrival/T0) can identify patients who might benefit from effective intervention, but they are less sensitive and specific for the endpoint. We hypothesized that early trend analysis of the P/F ratio would improve the predictive power of the T0 score. Methods: Retrospective review of 417 patients undergoing LTX at one institution from 1992 through June 2005. P/F ratios were measured at regular intervals in the first 72 hours post-transplant. Severe PGD was defined as a P/F ratio ⬍ 200. The P/F trend was calculated as the difference in the P/F ratio from T0 to 12 hours(T12). Results: Severe PGD was present in 97/417 (23.3%) of LTX patients at ICU arrival (T0). The overall 90-day death rate of this group was 17/97 (17.5%). Patients with a worsening trend in their P/F ratio (P/F change ⱕ 0) by T12 had a dramatically higher 90-day mortality rate and longer ICU stay compared with patients with an improving trend (Table 1). Medium-term survival of patients in the group with a worsening P/F trend was also poorer compared to the group with an improving trend (5 year survival: P/F change ⬎0, 44%, vs. P/F change ⬍0, 33%, p ⫽ 0.03 Log Rank). Conclusions: In LTX patients experiencing severe PGD upon ICU arrival, early trends in the P/F ratio identify subgroups with dramatically better and poorer outcomes compared to the overall group. Effective interventions guided by the P/F trend should improve survival following LTX. Outcomes After LTX In Patients With Severe PGD at T0, Grouped by P/F Change by T12 P/F change
90-day deaths
Median ICU days
⬎ 100 (n ⫽ 17) 1–100 (n ⫽ 26) ⱕ 0 (n ⫽ 54)
0 (0%) 2 (8%) 15 (28%)*
4 3 12*
*p ⬍ 0.001 compared to patients with P/F change ⬎ 0.
14 DYNAMIC CHANGES IN PLASMA ICAM AND VWF LEVELS IN PRIMARY GRAFT DYSFUNCTION AFTER LUNG TRANSPLANTATION J.D. Christie,1 S. Kawut,3 J. DeAndrade,2 A. Milstone,4 A. Weinacker,5 J. Orens,6 V. Lama,7 E. Demissie,1 S. Bellamy,1 L. Ware,4 the Lung Transplant Outcomes Group, 1University of Pennsylvania School of Medicine, Philadelphia, PA; 2University of Alabama, Birmingham, AL; 3Columbia University, New York, NY; 4 Vanderbilt University, Nashville, TN; 5Stanford University, Stanford, CA; 6Johns Hopkins University, Baltimore, MD; 7 University of Michigan, Ann Arbor, MI Background: The role of upregulation in intracellular adhesion molecule (ICAM) in the pathogenesis of experimental lung injury has been recognized, and Von Willebrand Factor antigen (VWF) has been suggested as a marker of acute lung injury. We hypothesized that plasma levels of ICAM and VWF levels would be elevated in PGD after lung transplant. Methods: Plasma levels of ICAM and VWF were measured at 6, 24, 48, and 72 hours following reperfusion in 128 lung transplant patients enrolled between 6/03 and 11/04 in the Lung Transplant Outcomes Group Cohort Study (including Penn, Columbia, Stanford, Vanderbilt, Michigan, and UAB). The primary outcome was PGD ISHLT Grade 3 (PaO2/FiO2⬍200 with alveolar infiltrates), at 72 hours postoperatively (T72). All plasma and clinical data were collected prospectively. ICAM and VWF were measured by ELISA and biomarker profiles were evaluated in multivariable analyses using generalized estimating equations (GEE).
The Journal of Heart and Lung Transplantation Volume 25, Number 2S
Results: Plasma ICAM levels were elevated within hours of reperfusion in those with Grade3 T72 PGD, and remained higher during the three day period. In contrast, VWF seemed to rise later in the course of lung injury. The mean plasma ICAM level measured at 6 hours following reperfusion in those with Grade 3 PGD at T72 was 338 ⫹/⫺ 155 vs. 255 ⫹/⫺ 122 in those with Grade 0, 1, and 2 PGD (p⫽0.014). The GEE contrast estimate for the association of ICAM with Grade 3 PGD was 107.5 (95% CI 38.7, 176.3), p⫽0.0022, indicating that on average the ICAM level was over 100 mg/dL higher in Grade 3 PGD than other grades over the 72 hour time course. This finding was unaltered by adjustment for recipient diagnosis, age, race, sex, donor age, sex, race, ischemic time, or use of cardiopulmonary bypass. Early VWF levels were not significantly different between the groups (p⫽0.27), and the VWF GEE did not show a significant difference over 72 hours (p⫽0.66). Conclusion: Elevated plasma ICAM levels are associated with prolonged severe acute lung injury following lung transplantation. 15 SERUM VEGF LEVELS IN LUNG TRANSPLANT RECIPIENTS PREDICT PRIMARY GRAFT DYSFUNCTION S. Aharinejad,1,2 K. Krenn,2 S. Taghavi,1 W. Klepetko,1 1 Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria; 2Laboratory for Cardiovascular Research, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria Background: Primary graft dysfunction (PGD) due to ischemiareperfusion injury is a severe complication in lung transplantation (LTX). Therapeutic strategies are limited and there are no standardized pre-operative markers to predict PGD. Vascular endothelial growth factor (VEGF) is a key regulator of vascular permeability. Methods: Pre-operative VEGF serum levels were assessed in 80 consecutive patients undergoing LTX by ELISA. Diseases leading to LTX were: COPD (n⫽30), cystic fibrosis (n⫽16), idiopathic pulmonary fibrosis (n⫽12), primary pulmonary hypertension (n⫽6), and others (n⫽16). The ischemia time of the grafts was 5 h ⫾ 65 min and the PaO2/FiO2 ratio of the donors was ⬎ 300. PGD was diagnosed and scored by characteristic changes in chest radiographs and PaO2/FiO2 ratio according to the guidelines of the International Society for Heart and Lung Transplantation, grading PGD from 0 to 3 within 72 hours after LTX (0 ⫽ none; 1 ⫽ only radiographic evidence; 2 ⫽ moderate, PaO2/FiO2 ratio 200 –300; 3 ⫽ severe, PaO2/FiO2 ratio ⬍ 200 or ECMO necessary). Results: Grade 3 PGD occurred in 15%, grade 2 in 23%, grade 1 in 43% and grade 0 in 19% of the patients. The pre-operative VEGF serum levels were significantly higher in patients with PGD grade 2 and 3 versus those without clinically relevant PGD (grade 0 and 1) following LTX (p⫽0.0007). Pre-operative recipient VEGF serum levels significantly predicted PGD in receiver operating characteristic curve analysis (p⫽0.0002, AUC⫽0.755, CI⫽1.001–1.003). Conclusions: Pre-operative serum VEGF levels in lung transplant patients could identify those at risk for PGD, and thus enable early intervention.
Abstracts
S49
Background: Lung transplantation can cause surfactant dysfunction that may be a contributing factor for primary graft dysfunction and graft failure. Aim: To study the effect of exogenous surfactant on post lung transplantation oxygenation and recovery. Study Design: Prospective open randomized controlled study. Patients: 22 subjects (14 men and 8 women), 20 underwent single lung transplantation due to Fibrosis (10), COPD (8), and retransplant for BOS (2), and 2 with double lung transplantation due to CF and bronchiectasis. Methods: In 18 patients 2 lungs were transplanted from the same donor for 2 recipients one patient was treated with surfactant while the other served as control. Otherwise surfactant was given in every other case. 20mg phospholipids/kg bovine surfactant was administered via a fiberoptic bronchoscope after establishment of bronchial anastomosis and ventilation of the transplanted lung. Results: Patients who received surfactant had better post operative oxygenation (mean PaO2/FIO2 430 vs. 290mmHg p⫽0.03), they were extubated earlier (mean 14.5 vs. 22.4 hours). There was a tendency towards shorter ICU stay among treated patients (2.4 vs. 7.7 days p⫽NS). One month vital capacity in was better in surfactant treated patients (58.6% vs. 48 % p⫽0.05) and FEV1 (57.3% vs. 48% p⫽NS). One control patient was reintubated after 3 days. One treated patient died from severe rejection after 61 days. Conclusions: Surfactant instillation during lung transplantation improves oxygenation, shortens intubation time and enhances early post transplantation recovery. Further larger studies are needed to asses the routine use of surfactant for the prevention of graft dysfunction and improvement of transplant outcome.
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HEART TRANSPLANTATION IN CHILDREN WITH MARKEDLY ELEVATED PULMONARY VASCULAR RESISTANCE G. Ofori-Amanfo,1 D. Hsu,1 J.M. Lamour,1 S. Mital,1 M.L. O’Byrne,1 A.J. Smerling,1 J.M. Chen,1 R. Mosca,1 L.J. Addonizio,1 1Pediatrics, Columbia University Medical Center, New York, NY
THE USE OF SURFACTANT IN LUNG TRANSPLANTATION: A RANDOMIZED CONTROL PILOT STUDY A. Amital,1 D. Shitrit,1 Y. Raviv,1 D. Bendayan,1 A. Kogan,2 G. Sahar,2 M. Saute,2 I. Bakal,1 M.R. Kramer,1 1Pulmonary Institute, Rabin Medical Center-Belinson Campus, Petach Tikva, Israel; 2Cardiothoracic Department, Rabin Medical CenterBelinson Campus, Petach Tikva, Israel
Markedly elevated pulmonary vascular resistance (PVRI) is associated with an increased risk of right ventricular failure (RVF) post-transplantation (Tx) and increased morbidity and mortality. A PVRI ⱖ6IU is a contraindication to heart Tx in many centers and pts are referred for higher risk heart-lung Tx. Method: We reviewed our 21-year experience of heart Tx in children with a PVRI ⱖ6IU. Among 263 children and young adults transplanted