Lung Transplant Recipients with Severe Primary Graft Dysfunction Requiring ECMO Had Similar Donor-Derived Cell-Free DNA Levels and Lung Function as Matched Controls

I. Timofte, A. Iacono, M. Terrin, R. Vesselinov, K. Bhatti, A. Marishta, C. Young, A. Pervaiz, U. Fideli, I. Tunc, D. M. Kwesiga, J. Orens, P. Shah, S. D. Nathan, A. W. Brown, H. A. Valantine, S. Agbor-Enoh

Research output: Contribution to journalArticle

Abstract

PURPOSE: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure in lung transplant recipients with severe primary graft dysfunction (PGD). There is limited information regarding the impact of post-op ECMO on lung allograft function. Circulating donor-derived cell-free DNA (dd-cf-DNA) has emerged as a potential biomarker of lung allograft injury. The goal of our study is to compare the dynamic dd-cf-DNA changes in patients that required ECMO support with changes in lung transplant patients that did not require ECMO. METHODS: Peri-transplant (pre-transplant and days 1, 3, 7 and 10, 14, 30, 60, 90 post-transplantation) plasma samples from lung transplant recipients (LTRs)of the Genomic Research Alliance for Transplantation (GRAfT) were analyzed for dd-cf-dDNA by next generation sequencing. After matching for gender, type of transplant (single versus double), and underlying diagnosis, the dd-cf-DNA levels and 3 month post-transplant lung function was compared among patients who required (n=9) and did not require (n=45) ECMO post-operatively. RESULTS: The dd-cf-DNA levels were similar between patients with PGD that required ECMO compared to non ECMO patients. The dd-cf-DNA levels for both ECMO patients and their matched controls were decreased by day 10 (Figure 1). The figure illustrates dd-cf-DNA trends for 2 matched cases (ECMO) and 10 controls (not ECMO), showing high initial post-transplant dd-cf-DNA levels followed by an exponential decay. There was no difference between lung function (FEV1) at 3 months between the ECMO patients and their matched controls (p=0.27)-Figure 2. CONCLUSION: This report suggests that despite a higher risk for postoperative mortality, patients with severe primary graft failure requiring ECMO had similar cfDNA dynamics and lung function at 3-months post-transplant.

ASJC Scopus subject areas

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

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