Figure 1The mean values of forced vital capacity before and U0126 after transplantation. The mean forced vital capacity (FVC) increased significantly from 1.41 �� 0.56 L observed at baseline (43 �� 14% of predicted, n = 10) to 1.97 �� 0.66 L at …Figure 2The mean values of forced expiratory volume in one second before and after transplantation. The mean forced expiratory volume in one second (FEV1) also increased significantly from 0.59 �� 0.26 L observed at baseline (20 �� 6% predicted; …There were two mortalities during the observation period. One patient died at five months due to sepsis resulting from profound pneumonia, while another died from chronic rejection at 19 months. By February 2009, 8 of the 10 patients were still alive and the cumulative survival rates at 3 months and at 12 months post-transplantation were 100% and 90%, respectively.
DiscussionIn this report, we describe the experience of 10 ventilator-dependent patients who underwent BSLTx via intraoperative VA ECMO support. There was neither postoperative nor in-hospital mortality and the pulmonary function values showed significant and continued improvement during the postoperative 12 months. Although BSLTx in this critical population had varied surgical complications and they needed longer ICU and hospital stays postoperatively, all the patients observed in this study were able to tolerate the transplant procedures. The 3-month and 12-month post-transplantation survival rates were 100% and 90%, respectively.
Since May 2005, a new allocation system was implemented in the United States that allocates donor lungs on the basis of medical urgency (risk of dying without transplant) and the net transplant benefit (opportunity for post-transplant survival) to avoid performing futile transplants [11]. In Taiwan, the total number of LTx was less than 120 in the period to February 2009 and it was very difficult to identify the factors associated with post-transplant survival in this small cohort of patients with diverse diagnoses. As the net transplant benefits are not calculated, this system can not avoid preferentially allocating scarce donor lungs to severely ill patients. Without any doubt, however, the allocation policy that top priority should be given to patients with the least amount of time to live and the current phenomenon in Taiwan whereby large numbers of LTx are performed in critically ill individuals indicate that this allocation system is not perfect and needs further detailed revision in the future.
Although outcomes of LTx have improved substantially in the past decade, the hospital mortality is still significant (10 to 15%) and the actuarial survival rates are 88% at three months and 81% at one year [12,13]. The high degree of illness of GSK-3 preoperative waitlisted patients was recognized as one of the major reasons contributing to the complicated postoperative recovery and high in-hospital mortality rate.