Extracorporeal membrane oxygenation as a bridge to lung re-transplantation: Is there a role?

Abstract

Background: In this study we sought to determine survival rates after use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung re-transplantation (re-LT).

Methods: Propensity-adjusted analysis was performed on data from the Scientific Registry of Transplant Recipients (SRTR) to evaluate survival in recipients between the years 1988 and 2012, based on the use of ECMO before re-LT.

Results: A total of 854 adult re-LT recipients were identified. Extracorporeal support had been used as a bridge in 55 (6.8%) of the recipients, whereas 799 (93.2%) had undergone re-LT without the use of ECMO. Compared with non-ECMO patients, the ECMO patients were more likely to have: higher body mass index (p = 0.003); received lungs from an older donor (p = 0.04); higher total bilirubin (p = 0.002); undergone bilateral lung transplantation (p = 0.01); diabetes (p = 0.04); mechanical ventilation (p < 0.0005); and been hospitalized in the intensive care unit (p < 0.0001). They were also more likely to have a diagnosis of bronchiolitis obliterans syndrome (p < 0.0001), be on inhaled nitric oxide (p < 0.0001), and have a shorter waitlist time before re-LT (p < 0.0001). Compared with the non-ECMO group, 30-day survival for the ECMO group was lower (67.3% vs 91.2%, p = 0.0002). Obesity was identified as a predictor of increased mortality in re-LT hazard ratio 2.97 (1.18 to 7.50), p = 0.02.

Conclusion: This contemporary analysis of survival after use of ECMO as a bridge to re-LT revealed lower survival in the ECMO group.

Keywords: extracorporeal membrane oxygenation; lung re-transplantation; mortality; outcomes; predictors.