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. 2018 Jul;156(1):440-448.e2.
doi: 10.1016/j.jtcvs.2018.01.101. Epub 2018 Feb 22.

Improvement in patient-reported outcomes after lung transplantation is not impacted by the use of extracorporeal membrane oxygenation as a bridge to transplantation

Nicholas A Kolaitis  1 , Allison Soong  2 , Pavan Shrestha  2 , Hanjing Zhuo  2 , John Neuhaus  3 , Patti P Katz  4 , John R Greenland  2 , Jeffrey Golden  2 , Lorriana E Leard  2 , Rupal J Shah  2 , Steven R Hays  2 , Jasleen Kukreja  5 , Mary Ellen Kleinhenz  2 , Paul D Blanc  2 , Jonathan P Singer  2
Affiliations

Improvement in patient-reported outcomes after lung transplantation is not impacted by the use of extracorporeal membrane oxygenation as a bridge to transplantation

Nicholas A Kolaitis et al. J Thorac Cardiovasc Surg. 2018 Jul.

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. The impact of preoperative ECMO on health-related quality of life (HRQL) and depressive symptoms after lung transplantation remains unknown, however.

Methods: In a single-center prospective cohort study, we assessed HRQL and depressive symptoms before and at 3, 6, and 12 months after lung transplantation using the Short Form 12 Physical and Mental Component Scores (SF12-PCS and SF12-MCS), Airway Questionnaire 20-Revised (AQ20R), EuroQol 5D (EQ5D), and Geriatric Depression Scale (GDS). Changes in HRQL were quantified by segmented linear mixed-effects models controlling for age, sex, diagnosis, preoperative forced expiratory volume in 1 second, 6-minute walk distance, and Lung Allocation Score. We compared changes in HRQL among subjects bridged with ECMO, subjects hospitalized but not on ECMO, and subjects called in for transplantation as outpatients.

Results: Out of 189 subjects, 17 were bridged to transplantation with ECMO. In all groups, improvements in HRQL following lung transplantation exceeded the minimally clinically important difference using the SF12-PCS, AQ20R, EQ5D, and GDS. HRQL defined by SF12-MCS did not change after transplantation. Improvements were generally similar among the groups, except for EQ5D, which showed a trend toward less benefit in the outpatients, possibly due to their better HRQL before lung transplantation.

Conclusions: Subjects ill enough to require ECMO as a bridge to lung transplantation appear to achieve similar improvements in HRQL and depressive symptoms as those who do not. It is reassuring to both providers and patients that lung transplantation provides substantial improvements in HRQL, even for those patients who are critically ill in the run up to transplantation.

Keywords: ECMO; HRQL; HRQoL; QOL; extracorporeal membrane oxygenation; health-related quality of live; lung transplantation; quality of life.

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Conflict of interest statement

Disclosures: The authors have no disclosures and no relevant conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart of subjects throughout the study
Left-sided column represents number of subjects providing data for analysis at each time point. The number of subjects at the three-month post-transplant time point was less than six month time point because we stopped administering surveys at 3 months post-transplant after July 2016. Right-sided column explains reasons for missing surveys at each time point.
Figure 2
Figure 2. Unadjusted plots of average health-related quality of life from before to one-year after lung transplantation
Unadjusted plots of average health-related quality of life (HRQL) from before to one-year after lung transplantation. (a) SF-12PCS (Generic-Physical HRQL); (b) SF-12MCS (Generic-Mental HRQL) (c); AQ20R (Respiratory Specific HRQL) (d); EQ5D (Health Utility HRQL); (e) GDS (Depression Scale). Red lines represent subjects who required ECMO as a bridge to transplant, blue lines represent subjects who were hospitalized but not on ECMO at the time of transplant and black lines represent subjects called in for transplant from the outpatient setting. Whiskers represent one standard deviation above and below the mean HRQL values for each time point. On the Y axis, the first horizontal black line denotes pre-transplant mean scores; the dashed and solid horizontal lines above denote a change in score equal to one- and two-times the minimally clinically important difference (MCID), respectively.
Figure 2
Figure 2. Unadjusted plots of average health-related quality of life from before to one-year after lung transplantation
Unadjusted plots of average health-related quality of life (HRQL) from before to one-year after lung transplantation. (a) SF-12PCS (Generic-Physical HRQL); (b) SF-12MCS (Generic-Mental HRQL) (c); AQ20R (Respiratory Specific HRQL) (d); EQ5D (Health Utility HRQL); (e) GDS (Depression Scale). Red lines represent subjects who required ECMO as a bridge to transplant, blue lines represent subjects who were hospitalized but not on ECMO at the time of transplant and black lines represent subjects called in for transplant from the outpatient setting. Whiskers represent one standard deviation above and below the mean HRQL values for each time point. On the Y axis, the first horizontal black line denotes pre-transplant mean scores; the dashed and solid horizontal lines above denote a change in score equal to one- and two-times the minimally clinically important difference (MCID), respectively.
Figure 2
Figure 2. Unadjusted plots of average health-related quality of life from before to one-year after lung transplantation
Unadjusted plots of average health-related quality of life (HRQL) from before to one-year after lung transplantation. (a) SF-12PCS (Generic-Physical HRQL); (b) SF-12MCS (Generic-Mental HRQL) (c); AQ20R (Respiratory Specific HRQL) (d); EQ5D (Health Utility HRQL); (e) GDS (Depression Scale). Red lines represent subjects who required ECMO as a bridge to transplant, blue lines represent subjects who were hospitalized but not on ECMO at the time of transplant and black lines represent subjects called in for transplant from the outpatient setting. Whiskers represent one standard deviation above and below the mean HRQL values for each time point. On the Y axis, the first horizontal black line denotes pre-transplant mean scores; the dashed and solid horizontal lines above denote a change in score equal to one- and two-times the minimally clinically important difference (MCID), respectively.
Figure 2
Figure 2. Unadjusted plots of average health-related quality of life from before to one-year after lung transplantation
Unadjusted plots of average health-related quality of life (HRQL) from before to one-year after lung transplantation. (a) SF-12PCS (Generic-Physical HRQL); (b) SF-12MCS (Generic-Mental HRQL) (c); AQ20R (Respiratory Specific HRQL) (d); EQ5D (Health Utility HRQL); (e) GDS (Depression Scale). Red lines represent subjects who required ECMO as a bridge to transplant, blue lines represent subjects who were hospitalized but not on ECMO at the time of transplant and black lines represent subjects called in for transplant from the outpatient setting. Whiskers represent one standard deviation above and below the mean HRQL values for each time point. On the Y axis, the first horizontal black line denotes pre-transplant mean scores; the dashed and solid horizontal lines above denote a change in score equal to one- and two-times the minimally clinically important difference (MCID), respectively.
Figure 2
Figure 2. Unadjusted plots of average health-related quality of life from before to one-year after lung transplantation
Unadjusted plots of average health-related quality of life (HRQL) from before to one-year after lung transplantation. (a) SF-12PCS (Generic-Physical HRQL); (b) SF-12MCS (Generic-Mental HRQL) (c); AQ20R (Respiratory Specific HRQL) (d); EQ5D (Health Utility HRQL); (e) GDS (Depression Scale). Red lines represent subjects who required ECMO as a bridge to transplant, blue lines represent subjects who were hospitalized but not on ECMO at the time of transplant and black lines represent subjects called in for transplant from the outpatient setting. Whiskers represent one standard deviation above and below the mean HRQL values for each time point. On the Y axis, the first horizontal black line denotes pre-transplant mean scores; the dashed and solid horizontal lines above denote a change in score equal to one- and two-times the minimally clinically important difference (MCID), respectively.
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References

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