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. 2022 Oct 3;11(19):5859.
doi: 10.3390/jcm11195859.

The Impact of New Treatments on Short- and MID-Term Outcomes in Bilateral Lung Transplant: A Propensity Score Study

Annalisa Boscolo  1 , Andrea Dell'Amore  2 , Tommaso Pettenuzzo  1 , Nicolò Sella  1 , Alessandro De Cassai  1 , Elisa Pistollato  3 , Nicola Cacco  3 , Andrea Manzan  3 , Agnese De Carolis  3 , Federico Geraldini  1 , Giulia Lorenzoni  4 , Federica Pezzuto  5 , Giovanni Zambello  2 , Marco Schiavon  2 , Fiorella Calabrese  5 , Dario Gregori  4 , Emanuele Cozzi  5   6 , Federico Rea  2 , Paolo Navalesi  1   3
Affiliations

The Impact of New Treatments on Short- and MID-Term Outcomes in Bilateral Lung Transplant: A Propensity Score Study

Annalisa Boscolo et al. J Clin Med. .

Abstract

Background: Despite many efforts to improve organ preservation and recipient survival, overall lung transplant (LT) mortality is still high. We aimed to investigate the impact of 'prophylactic' veno-arterial extracorporeal membrane oxygenation (VA ECMO) and tacrolimus on 72-h primary graft dysfunction (PGD) and 30-day acute cellular rejection, respectively.

Methods: All consecutive LT patients admitted to the Intensive Care Unit of the Padua University Hospital (February, 2016-2022) were screened. Only adult patients undergoing first bilateral LT and not requiring cardio-pulmonary bypass, invasive mechanical ventilation, and/or ECMO before LT, were included. A propensity score weighting analysis was employed to account for the non-random allocation of the subjects to different treatments.

Results: A total of 128 LT recipients were enrolled. Compared to the 'off-pump'-group (n.47, 37%), 'prophylactic' VA ECMO (n.51,40%) recorded similar 72-h PGD values, perioperative blood products and lower acute kidney dysfunction. Compared with cyclosporine (n.86, 67%), tacrolimus (n.42, 33%) recorded a lower risk of 30-day cellular rejection, kidney dysfunction, and bacteria isolation.

Conclusions: 'Prophylactic' VA ECMO recorded 72-h PGD values comparable to the 'off-pump'-group; while tacrolimus showed a lower incidence of 30-day acute cellular rejection.

Keywords: ECMO; VA ECMO; intensive care; lung transplant; tacrolimus; transplantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of enrolled patients. Abbreviations: CPB, cardio-pulmonary bypass; ECMO, extracorporeal membrane oxygenation; LT, lung transplantation; n, number.
Figure 2
Figure 2
Propensity score (‘off-pump’ vs. ‘prophylactic’ VA ECMO versus ‘rescue’ device). The standardized mean differences before (red dots) and after (blue dots) the propensity score weighting procedure for the variables used in the propensity score estimation. Abbreviations: BMI, body mass index; LAS, lung allocation score; VA ECMO, veno-arterial extra-corporeal membrane oxygenation.
Figure 3
Figure 3
Propensity score (tacrolimus versus cyclosporine-group). The standardized mean differences before (red dots) and after (blue dots) the propensity score weighting procedure for the variables used in the propensity score estimation. Abbreviations: BMI, body mass index; LAS, lung allocation score.
See this image and copyright information in PMC

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