Kidney Week

Abstract: SA-PO667

Rescue Therapy with Extracorporeal Membrane Oxygenation (ECMO) for Diffuse Alveolar Haemorrhage in Patients with Systemic Vasculitis

Session Information

• Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Jesus Silva, Jorge, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Jorge Jesus Silva,

• Bell, Ricky, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Ricky Bell,

• Topham, Peter S., University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Peter S. Topham,

• Al-Jayyousi, Reem, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Reem Al-Jayyousi,

Background

Diffuse alveolar haemorrhage (DAH) is a life threatening condition and common causes include autoimmune diseases, infections and medications among others. DAH is a severe manifestation of systemic vasculitis, particularly in patients with ANCA and anti-GBM antibodies. This is mediated through inflammation, occupation and destruction of the alveoli. In extreme cases, even mechanical ventilation is ineffective and ECMO is required to oxygenate the blood whilst the immunosuppressive treatment takes effect.

Methods

We performed a retrospective review of the patients with confirmed DAH which required ECMO at our centre between 01/2016 and 04/2019. Each case was reviewed and we assessed baseline characteristics, cause of vasculitis, duration of ECMO, immunosuppressive therapies used, renal outcome and mortality.

Results

8 patients met the inclusion criteria making this the largest single centre case series to date of patients with DAH requiring ECMO. 6 patients were female and 2 male with a median age of 42.5 years. 6 patients had ANCA associated vasculitis (5 PR3, 1 MPO), 1 had systemic lupus erythematosus (SLE) and 1 was ANCA and anti-GBM negative. After commencing ECMO, 7 patients survived; of those 4 received IV cyclophosphamide, and 5 received rituximab; all had IV methylprednisolone and plasmapheresis (PLEX). 6 of the 8 patients presented AKI and 5 required continuous renal replacement therapy (CRRT); at discharge 5 patients had renal recovery with a GFR back to baseline.

Conclusion

The majority of cases with catastrophic DAH are related to AAV and in those failing invasive mechanical ventilation, ECMO would appear to be a valid rescue therapy with good overall outcomes. Immunosuppression with IV CYC and/or IV RTX appears to be safe and effective in this setting. Despite a high incidence of AKI requiring RRT, the majority of patients achieved renal recovery.