In
lung transplantation, postoperative outcomes favor intraoperative use of
extracorporeal membrane oxygenation (ECMO) over
cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury
biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral
lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury
biomarkers including
syndecan-1 (SYN-1),
intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of
primary graft dysfunction grade 3 (
PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and
ICAM-1 were significantly higher in recipients who developed
PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed
acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon
intensive care arrival was found to be a significant predictive
biomarker of
PGD3,
acute kidney injury, and hepatic dysfunction following
lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following
lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve
lung transplantation outcomes.