CARDIOPULMONARY BYPASS IS ASSOCIATED WITH EARLY ALLOGRAFT DYSFUNCTIONBUT NOT DEATH AFTER DOUBLE-LUNG TRANSPLANTATION

Objectives: To assess the effect of cardiopulmonary bypass on allograf t function and recipient survival in double-lung transplantation. Meth ods: Retrospective review of 94 double-lung transplantations. Results: Cardiopulmonary bypass was used in 37 patients (CPB); 57 transplantat ions were accomplished without bypass (no-CPB), Bypass was routinely u sed for patients with pulmonary hypertension (n = 27) and for two reci pients undergoing en bloc transplantation. Cardiopulmonary bypass was required in eight (12.3%) of the remaining 65 patients, Mean ischemic time was longer in the CPB group (346 vs 315 minutes, p = 0.04). The C PB group required more perioperative blood (11.4 vs 6.0 units, p = 0.0 1), Allograft function, assessed by the arterial/alveolar oxygen tensi on ratio, was better in the no-CPB group at 12 and 24 hours after oper ation (0.54 vs 0.39 at 12 hours, p = 0.002; and 0.63 vs 0.38 at 24 hou rs, p = 0.001), The CPB group had more severe pulmonary infiltrates at both 1 and 24 hours (p = 0.005), Diffuse alveolar damage was more com mon in the CPB group (69% vs 35%, p = 0.002), Median duration of intub ation was longer in the CPB group (10 days) than in the no-CPB group ( 2 days, p = 0.002), The 30-day mortality rate (13.5% vs 7.0% in the CP B and no-CPB groups) and 1-year survival (65% vs 67%, CPB and no-CPB) were not significantly different, Conclusions: In the absence of pulmo nary hypertension, cardiopulmonary bypass is only occasionally necessa ry in double-lung transplantation. Bypass is associated with substanti al early allograft dysfunction after transplantation.