Modified Low-Flow Ultrafiltration Ameliorates Hemodynamics and Early Graft Function and Reduces Blood Loss in Living-Donor Lobar Lung Transplantation

Yasuhiro Kotani, Osami Honjo, Keiji Goto, Yasufumi Fujita, Atsushi Ito, Mahito Nakakura, Masaaki Kawada, Shunji Sano, Kazutoshi Kotani, Hiroshi Date

Research output: Contribution to journalArticle

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Abstract

Background: This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT). Method: The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed. Results: There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p <0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2; 411 ± 107 vs 272 ± 107 mm Hg, p <0.05) and the alveolar-arterial oxygen difference (a-aDO2; 158 ± 84 vs 315 ± 127 mm Hg, p <0.05) at 15 minutes after CPB. There were no differences in PaO2/FiO2 and A-aDO2 between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p <0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups. Conclusions: The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.

Original languageEnglish
Pages (from-to)340-346
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume28
Issue number4
DOIs
Publication statusPublished - Apr 2009

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Lung Transplantation
Living Donors
Ultrafiltration
Cardiopulmonary Bypass
Hemodynamics
Blood Transfusion
Transplants
Oxygen
Control Groups
Blood Pressure
Intensive Care Units
Ventilation
Length of Stay
Arterial Pressure
Gases
Pressure
Lung
Survival

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Modified Low-Flow Ultrafiltration Ameliorates Hemodynamics and Early Graft Function and Reduces Blood Loss in Living-Donor Lobar Lung Transplantation. / Kotani, Yasuhiro; Honjo, Osami; Goto, Keiji; Fujita, Yasufumi; Ito, Atsushi; Nakakura, Mahito; Kawada, Masaaki; Sano, Shunji; Kotani, Kazutoshi; Date, Hiroshi.

In: Journal of Heart and Lung Transplantation, Vol. 28, No. 4, 04.2009, p. 340-346.

Research output: Contribution to journalArticle

Kotani, Yasuhiro ; Honjo, Osami ; Goto, Keiji ; Fujita, Yasufumi ; Ito, Atsushi ; Nakakura, Mahito ; Kawada, Masaaki ; Sano, Shunji ; Kotani, Kazutoshi ; Date, Hiroshi. / Modified Low-Flow Ultrafiltration Ameliorates Hemodynamics and Early Graft Function and Reduces Blood Loss in Living-Donor Lobar Lung Transplantation. In: Journal of Heart and Lung Transplantation. 2009 ; Vol. 28, No. 4. pp. 340-346.
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T1 - Modified Low-Flow Ultrafiltration Ameliorates Hemodynamics and Early Graft Function and Reduces Blood Loss in Living-Donor Lobar Lung Transplantation

AU - Kotani, Yasuhiro

AU - Honjo, Osami

AU - Goto, Keiji

AU - Fujita, Yasufumi

AU - Ito, Atsushi

AU - Nakakura, Mahito

AU - Kawada, Masaaki

AU - Sano, Shunji

AU - Kotani, Kazutoshi

AU - Date, Hiroshi

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N2 - Background: This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT). Method: The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed. Results: There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p <0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2; 411 ± 107 vs 272 ± 107 mm Hg, p <0.05) and the alveolar-arterial oxygen difference (a-aDO2; 158 ± 84 vs 315 ± 127 mm Hg, p <0.05) at 15 minutes after CPB. There were no differences in PaO2/FiO2 and A-aDO2 between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p <0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups. Conclusions: The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.

AB - Background: This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT). Method: The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed. Results: There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p <0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2; 411 ± 107 vs 272 ± 107 mm Hg, p <0.05) and the alveolar-arterial oxygen difference (a-aDO2; 158 ± 84 vs 315 ± 127 mm Hg, p <0.05) at 15 minutes after CPB. There were no differences in PaO2/FiO2 and A-aDO2 between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p <0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups. Conclusions: The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.

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