Sreeja Biswas Roy, Ariba Moin, Artur Rybachok, Mark Shacker, Ashwini Arjuna, Rajat Walia, Samad Hashimi, Jasmine Huang, Michael A. Smith, Ross M. Bremner
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Baseline patient characteristics, perioperative outcomes, and short-term survival were compared between eras.</p>\n </section>\n \n <section>\n \n <h3> RESULTS</h3>\n \n <p>A total of 2982 patients were included: 1866 with ECMO-bridge (LAS-ECMO: 1597; CAS-ECMO: 269) and 1116 with MV-bridge (LAS-MV: 1072; CAS-MV: 44). MV-bridge use was higher during LAS than CAS (LAS, 2.9% vs. CAS, 0.8%, <i>p</i> < 0.001), whereas ECMO-bridge was higher in the CAS era (LAS, 4.3% vs. CAS, 5.3%, <i>p</i> = 0.03). Recipient age was higher for both MV-bridge and ECMO-bridge cohorts in the CAS era. Median waitlist times were shorter, and median ischemic time and donor organ travel distances were longer in the CAS era for both MV and ECMO cohorts. Perioperative outcomes and 30-day and 90-day survival were comparable between eras. Waitlist mortality and delisting rates for medical deterioration were lower in the CAS era.</p>\n </section>\n \n <section>\n \n <h3> CONCLUSIONS</h3>\n \n <p>Rates of ECMO-bridge to transplant increased in the CAS era compared to the LAS era. Although the donor lung travel distances were longer, perioperative outcomes were comparable to those of the LAS era. Long-term outcomes of BTT candidates in the CAS era remain to be seen.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bridging the Gap: A Comparative Analysis of Patients Requiring Mechanical Ventilation or ECMO as a Bridge to Lung Transplant Between Eras\",\"authors\":\"Sreeja Biswas Roy, Ariba Moin, Artur Rybachok, Mark Shacker, Ashwini Arjuna, Rajat Walia, Samad Hashimi, Jasmine Huang, Michael A. Smith, Ross M. Bremner\",\"doi\":\"10.1111/ctr.70337\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> BACKGROUND</h3>\\n \\n <p>We compared trends and outcomes of lung transplant recipients who were bridged to transplantation using mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) during the new Composite Allocation Score (CAS) era or the previous Lung Allocation Score (LAS) era.</p>\\n </section>\\n \\n <section>\\n \\n <h3> METHODS</h3>\\n \\n <p>The United Network for Organ Sharing database was queried for all adult lung transplant recipients bridged to transplant with MV or ECMO during the LAS (April 5, 2005 to August 3, 2023) or CAS (September 3, 2023 to September 30, 2024) era. 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引用次数: 0
摘要
背景：我们比较了在新的复合分配评分（CAS）时代和以前的肺分配评分（LAS）时代，使用机械通气（MV）或体外膜氧合（ECMO）进行移植的肺移植受者的趋势和结果。方法查询美国器官共享网络数据库中LAS（2005年4月5日至2023年8月3日）或CAS（2023年9月3日至2024年9月30日）时代所有接受MV或ECMO桥接移植的成人肺移植受者。两期患者的基线特征、围手术期结局和短期生存比较。结果共纳入2982例患者：ECMO-bridge组1866例（LAS-ECMO: 1597例；CAS-ECMO: 269例），MV-bridge组1116例（LAS-MV: 1072例；CAS-MV: 44例）。LAS期间mv桥的使用率高于CAS (LAS, 2.9% vs. CAS, 0.8%, p < 0.001)，而ecmo桥的使用率在CAS时期更高（LAS, 4.3% vs. CAS, 5.3%, p = 0.03）。在CAS时代mv -桥组和ecmo -桥组的接受者年龄都较高。中位等待时间更短，中位缺血时间和供体器官运输距离在CAS时代对于MV和ECMO队列都更长。两期围手术期预后、30天和90天生存率具有可比性。在CAS时代，等待名单的死亡率和医疗恶化的退市率较低。结论：与LAS时代相比，CAS时代ecmo桥接移植率增加。尽管供体肺移动距离较长，但围手术期结果与LAS时代相当。BTT候选人在CAS时代的长期结果仍有待观察。
Bridging the Gap: A Comparative Analysis of Patients Requiring Mechanical Ventilation or ECMO as a Bridge to Lung Transplant Between Eras
BACKGROUND
We compared trends and outcomes of lung transplant recipients who were bridged to transplantation using mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) during the new Composite Allocation Score (CAS) era or the previous Lung Allocation Score (LAS) era.
METHODS
The United Network for Organ Sharing database was queried for all adult lung transplant recipients bridged to transplant with MV or ECMO during the LAS (April 5, 2005 to August 3, 2023) or CAS (September 3, 2023 to September 30, 2024) era. Baseline patient characteristics, perioperative outcomes, and short-term survival were compared between eras.
RESULTS
A total of 2982 patients were included: 1866 with ECMO-bridge (LAS-ECMO: 1597; CAS-ECMO: 269) and 1116 with MV-bridge (LAS-MV: 1072; CAS-MV: 44). MV-bridge use was higher during LAS than CAS (LAS, 2.9% vs. CAS, 0.8%, p < 0.001), whereas ECMO-bridge was higher in the CAS era (LAS, 4.3% vs. CAS, 5.3%, p = 0.03). Recipient age was higher for both MV-bridge and ECMO-bridge cohorts in the CAS era. Median waitlist times were shorter, and median ischemic time and donor organ travel distances were longer in the CAS era for both MV and ECMO cohorts. Perioperative outcomes and 30-day and 90-day survival were comparable between eras. Waitlist mortality and delisting rates for medical deterioration were lower in the CAS era.
CONCLUSIONS
Rates of ECMO-bridge to transplant increased in the CAS era compared to the LAS era. Although the donor lung travel distances were longer, perioperative outcomes were comparable to those of the LAS era. Long-term outcomes of BTT candidates in the CAS era remain to be seen.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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