Lung transplantation for acute respiratory distress syndrome: A multicenter experience

Abstract

Acute respiratory distress syndrome (ARDS) is a rapidly progressive lung disease with a high mortality rate. Although lung transplantation (LTx) is a well-established treatment for a variety of chronic pulmonary diseases, LTx for acute lung failure (due to ARDS) remains controversial. We reviewed posttransplant outcome of ARDS patients from three high-volume European transplant centers. Demographics and clinical data were collected and analyzed. Viral infection was the main reason for ARDS (n = 7/13, 53.8%). All patients were admitted to ICU and required mechanical ventilation, 11/13 were supported with ECMO at the time of listing. They were granted a median LAS of 76 (IQR 50-85) and waited for a median of 3 days (IQR 1.5-14). Postoperatively, median length of mechanical ventilation was 33 days (IQR 17-52.5), median length of ICU and hospital stay were 39 days (IQR 19.5-58.5) and 54 days (IQR 43.5-127). Prolongation of peripheral postoperative ECMO was required in 7/13 (53.8%) patients with a median duration of 2 days (IQR 2-7). 30-day mortality was 7.7%, 1 and 5-year survival rates were calculated as 71.6% and 54.2%, respectively. Given the lack of alternative treatment options, the herein presented results support the concept of offering live-saving LTx to carefully selected ARDS patients.

Keywords: clinical research/practice; health services and outcomes research; lung (allograft) function/dysfunction; lung failure/injury; lung transplantation/pulmonology.

FIGURE 1

PGD grading: PGD grading according to the ISHLT guidelines within the first 72 h postoperative for all 13 patients. Four out of 13 (30.8%) patients with a prolonged prophylactic ECMO support were graded as PGD “ungradable” at T 24 h. PGD grade 3 was seen in 6 (46.2%) patients. Graft function improved significantly thereafter and only three patients remained in PGD 3 at T72 h [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Survival curve 1998–2020: Kaplan–Meier survival curve of all 13 ARDS patients who received a lung transplantation demonstrates 1‐year and 5‐year survival rates of 71.6% and 54.2%, respectively [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Schematic diagram of all 13 patients. All 13 ARDS patients are shown chronically, starting with the time of listing for LTx. Postoperative events such as postoperative bleeding, duration of prolonged ECMO and mechanical ventilation are demonstrated as time points (postoperative days) after LTx. Follow‐up time is defined as the time of discharge from hospital to the last follow‐up visit. Aspergillus fum., Aspergillus fumigatus; C.albicans, Candida albicans; C.paraps., Candida parapsilosis; CoNs, Coagulase‐negative staphylococci; Haemoph.infl., Haemophilus influenzae; HSV1, herpes simplex virus; Legionella pneum., Kleb.oxyt., Klebsiella oxytoca; Legionella pneumophila; Morax.lac., Moraxella lacunata; m.r.g.‐infect, multi‐resistant gram‐negative infection; Pseud.a., Pseudomonas aeruginosa; Staph.a., Staphylococcus aureus; Staph. epid., Staphylococcus epidermidis; Strep.pneum., Streptococcus pneumoniae [Colour figure can be viewed at wileyonlinelibrary.com]