Extracorporeal membrane oxygenation bridge to pediatric lung transplantation: Modern era analysis

Abstract

Background: Survival outcomes of children on extracorporeal membrane oxygenation (ECMO) at time of lung transplant (LTx) remain unclear.

Methods: Pediatric first-time LTx recipients transplanted between January 2000 and December 2020 were identified in the United Network for Organ Sharing Registry to compare post-transplant survival according to ECMO support at time of transplant. For a comprehensive analysis of the data, univariate analysis, multivariable Cox regression, and propensity score matching were performed.

Results: During the study period, 954 children under 18 years of age underwent LTx with 40 patients on ECMO. We did not identify a post-LTx survival difference between patients receiving ECMO when compared to those that did not. A multivariable Cox regression model (Hazard ratio = 0.83; 95% confidence interval: 0.47, 1.45; p = .51) did not demonstrate an increased risk for death post-LTx. Lastly, a propensity score matching analysis, retaining 33 ECMO and 33 non-ECMO patients, further confirmed no post-LTx survival difference comparing ECMO to no ECMO cohorts (Hazard ratio = 0.98; 95% confidence interval: 0.48, 2.00; p = .96).

Conclusions: In this contemporary cohort of children, the use of ECMO at the time of LTx did not negatively impact post-transplant survival.

Keywords: extracorporeal membrane oxygenation (ECMO) support; lung transplant; pediatrics; post-lung transplant survival.

Figure 1.

Transplant Free Survival: Kaplan-Meier estimates of survival probability for patients with ECMO (red), and without ECMO (blue). Shaded areas are 95% confidence intervals and log rank p-value= 0.25.