SEARCHCOHORTsurgery, pulmonology

cohort·surgery, pulmonology, immunology, critical care, observational study·PMC10256326

HLA Sensitization in Patients Bridged to Lung Transplantation With Extracorporeal Membrane Oxygenation

Transplantation Direct · 7 authors, 2 centres

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TL;DR

This retrospective cohort study of 27 lung transplant candidates bridged with ECMO found that 29.6% developed new HLA antibody sensitization during support. No specific predisposing factors were identified, and sensitized patients showed non-significant trends toward worse posttransplant outcomes.

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611 CHARS

This single-center retrospective cohort study analyzed 27 patients bridged to lung transplantation with extracorporeal membrane oxygenation (ECMO) for at least 7 days between January 2016 and April 2022. The study did not identify any statistically significant risk factors for sensitization, including infection episodes, blood product transfusion, ECMO strategy, or duration. Among the 18 patients who survived to transplant, sensitized patients demonstrated non-significant trends toward a higher rate of primary graft dysfunction (PGD), a need for posttransplant ECMO support, and decreased 1-year survival.

STUDY TYPE

cohort

SPECIALTY

surgery

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AI pipeline

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ORIGINAL PAPER

PMC10256326

HLA Sensitization in Patients Bridged to Lung Transplantation With Extracorporeal Membrane Oxygenation

Transplantation Direct

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ABSTRACT

Background. Lung transplantation is a definitive therapy for many end-stage lung pathologies. Extracorporeal membrane oxygenation (ECMO) is increasingly being used as a bridge to lung transplantation (BTT). HLA sensitization is a major barrier to lung transplantation. The development of HLA sensitization while undergoing ECMO support as a BTT has recently been reported in a 2-patient series. Methods. We performed a retrospective analysis of patients undergoing ECMO as a BTT at a single large academic medical center from January 2016 to April 2022. The study was approved by the institutional review board. We selected patients who had undergone ECMO support for at least 7 d with either negative HLA before cannulation or initial negative HLA on ECMO (3 patients). Results. We identified 27 patients bridged to lung transplantation with available HLA data. Of this group, 8 patients (29.6%) developed significant HLA sensitization (>10%). We did not identify any factors predisposing to sensitization, including infection episodes or blood product transfusion. Sensitized patients demonstrated a trend toward an increased primary graft dysfunction rate, a need for posttransplant ECMO support, and a decreased 1-y survival; however, these did not meet statistical significance. Conclusions. Our study is the largest series today describing the association between HLA sensitization and ECMO therapy. We suggest that interaction between the immune system and ECMO circuit contributes to allosensitization pretransplant, similar to that occurring with ventricular assist device. Further work is needed to better characterize the incidence of HLA sensitization in a multicenter cohort and to identify potentially modifiable factors associated with HLA sensitization.

CITATION EXPORT

Ryan L. Goetz, Thomas S. Kaleekal, Keith M. Wille et al.. HLA Sensitization in Patients Bridged to Lung Transplantation With Extracorporeal Membrane Oxygenation. Transplantation Direct. (2023). https://doi.org/10.1097/TXD.0000000000001497

AUTHORS

7 · 2 CENTRES

Ryan L. Goetz, Thomas S. Kaleekal, Keith M. Wille, Erik Orozco-Hernandez, Enrique Gongora, Charles W. Hoopes, Victoria Rusanov

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL.
2 Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.