Extracorporeal membrane oxygenation as a bridge to lung transplantation

Abstract

The occurrence of severe graft failure after lung transplantation whichappears refractory to conventional treatment represents a difficultsituation with regard to the therapeutic strategies available. Of 17patients undergoing single lung transplantation at our center, 2 developedearly graft failure. In both, temporary artificial cardiopulmonary supportby means of extracorporeal membrane oxygenation became necessary as abridge to retransplantation. Both patients were successfully retransplantedafter 8 h and 232 h, respectively, of extra- corporeal support.Postoperatively, there was a variety of complications. The first patientcompletely recovered from temporary severe cerebral dysfunction diagnosedas "locked-in syndrome". She was discharged from hospital on the 93rdpostoperative day and remains alive and well 10 months after her operation.The other patient recovered well early after retransplantation. Later,however, airway problems developed, requiring the implantation ofendotracheal stents. Cachexia and several episodes of viral pneumoniacontributed to the progressive deterioration of her clinical status. Shefinally died after being hospitalized for 5 months after the originaloperation. These two cases illustrate the feasibility of usingextracorporeal membrane oxygenation as a bridge to pulmonarytransplantation.