In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal
membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the
effect of intraoperative support strategies on endothelial injury biomarkers and short-term
posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support,
venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant
were collected for Luminex assay to measure endothelial injury biomarkers including
syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9.
Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival
in the intensive care unit was significantly higher with CPB compared to V-A ECMO
and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0%
in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher
in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly
higher in patients who developed acute kidney injury and hepatic dysfunction after
transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant
predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following
lung transplantation. CPB is associated with higher plasma concentrations of SYN-1,
a marker of endothelial glycocalyx degradation, upon arrival to the intensive care
unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung
transplantation. Our data suggests that intraoperative strategies aimed at modulating
endothelial injury will help improve lung transplantation outcomes.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AKI (acute kidney injury), BMI (body mass index), CIT (cold ischemic time), CPB (cardiopulmonary bypass), ECLS (extracorporeal life support), ECMO (extracorporeal membrane oxygenation), ICAM-1 (intercellular adhesion molecule 1), ICU (intensive care unit), MMP (matrix metalloprotease), MV (mechanical ventilation), PGD (primary graft dysfunction), RBC (red blood cells), RRT (renal replacement therapy), SYN-1 (syndecan-1), UNOS (United Network for Organ Sharing), V-A ECMO (veno-arterial extracorporeal membrane oxygenation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 27, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: Funding provided by the University of Pittsburgh Medical Center Dept of Cardiothoracic Surgery
Disclosures: All authors declare no conflict of interests. Kentaro Noda reports research grant from CareDx, Inc. James D Luketich reports stock/stock options from Cigna, Intuitive Surgical, United Therapeutics, and Smith and Nephew.
IRB Approval: STUDY19080225, 12/10/2019.
This manuscript was a presentation at AATS 2022.
Read at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.
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