Impact of pretransplant extracorporeal membrane oxygen support duration on lung transplant outcomes: United Network for Organ Sharing analysis

Objective

The use of pretransplant extracorporeal membrane oxygenation (ECMO) continues to increase. In the most recent Scientific Registry for Transplant Recipients, 11% of listed candidates for lung transplantation were on ECMO. We evaluated the impact of the duration of ECMO bridge to transplantation on posttransplant outcomes using United Network for Organ Sharing data.

Methods

We performed a retrospective cohort study from January 1, 2015, to December 31, 2019, to include pre−COVID-19 pandemic data. Patients were grouped into quartiles on the basis of duration of ECMO support (<4, 4-8, 9-17, and >17 days). The primary outcome was survival at 1 year after transplantation. Secondary outcomes included length of stay from transplant to discharge, 1-month survival, 6-month survival.

Results

In total, 489 patients were analyzed. Median age decreased over the quartiles (quartile 1 age 55 vs quartile 4 age 37; P < .001). The proportion of patients who were ambulatory on ECMO support increased over the quartiles (quartile 1 was 23.85% vs quartile 4 was 63.87%; P < .001). Survival at 1 year was not different among the quartiles after adjusting for lung allocation score, body mass index, gender, ambulatory status, type of lung transplant, and creatinine. Six-month survival was reduced in the patients on prolonged ECMO support (quartiles 3 and 4). Ambulatory status, creatinine, and body mass index were significant contributors to survival at 1 year in the adjusted analysis.

Conclusions

Duration of pretransplant ECMO bridge to transplantation appears to impact 6-month survival in patients who were on ECMO for 9 days or longer, but duration of ECMO support does not appear to negatively impact postlung transplant survival during the first year or length of stay from transplant to discharge.