Pre-heart transplantation ECMO support achieved favorable post-transplant outcomes in selected patients. - 25/12/18
, G. Lebreton 1, P. Demondion 1, N. Jacob 1, L. Nguyen 1, A. Combes 2, J. Amour 3, S. Ouldamar 1, V. Shaida 1, P. Leprince 1Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
Pre-heart transplantation (HTx) ECMO support has been associated with poor short-term post-transplant outcomes.
Purpose |
To analyze post-HTx outcomes in patients under ECMO support at our center. Our local strategy is to associate an intra-aortic ballon pump to ECMO, to maintain ECMO after HTx and to propose HTx to selected patients with “isolated cardiac failure” (without mechanical ventilation; creatinine clearance>40mL/min).
Methods |
We performed a restrospective single-center observational study. We included all consecutive patients with a first non-combined HTx performed at our center between 2012 and 2016. We aimed to compare outcomes between patients under ECMO support at the time of HTx to patients without. The primary outcome was all-cause mortality after HTx.
Results |
Four hundred and fifteen patients met the inclusion criteria, including 118 patients (28.4%) under ECMO support at the time of HTx. Patients were mostly males (79%) and mean age was 50.8±12.4 years. ECMO patients were younger but had a longer ischemic time compared to other patients. Median time under ECMO before HTx was 9 days (IQR=5–15). Survival was similar between both groups (see Fig. 1, 1 and 3 years survival was respectively 85 and 80% in the ECMO-group compared to 81 and 72% in the no-ECMO-group). Only recipient age (HR=1.22 per 10-year increment), recipient BMI (HR=3.93 for BMI<18.5 compared to BMI 18.5 to 25kg/m2), creatinine clearance (HR=2.35 for clearance between 30 and 60mL/min; HR=3.73 for clearance<30mL/min compared to clearance≥90mL/min) and ischemic time (HR=1.03 per 1-hour increment) were independent risk factors for all-cause mortality. Rejection-free survival was comparable between groups. ECMO-related local wound infection was the most prevalent complication (37% of patients).
Conclusion |
HTx in selected patients under ECMO support at the time of transplantation achieved favorable outcomes in selected “isolated cardiac failure” patients.
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Vol 11 - N° 1
P. 42-43 - janvier 2019 Retour au numéro
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