Science and Research

Extracorporeal membrane oxygenation as a bridge to lung transplantation may not impact overall mortality risk after transplantation: results from a 7-year single-centre experience

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has an important role in bridging patients to lung transplantation. In this study, we present our experience with pretransplant ECMO during the last 7 years and investigate its impact on graft outcomes. METHODS: Records of all lung-transplanted patients at our institution between January 2010 and April 2017 were retrospectively reviewed. Graft survival was compared between patients who required pretransplant ECMO (pre-Tx ECMO+) and patients who did not (pre-Tx ECMO-). Risk factors for in-hospital mortality and graft survival were identified using a binary logistic regression and the Cox regression analyses, respectively. RESULTS: Among the 917 patients transplanted during the study period, 68 (7%) required ECMO as a bridge to transplantation [awake strategy, n = 57 (84%) patients]. Median bridging time was 9 days. Among pre-Tx ECMO+ patients, the need for haemodialysis at any point during bridging emerged as an independent risk factor for in-hospital mortality (odds ratio 7.79, 95% confidence interval 1.21-50.24; P = 0.031). Although in-hospital mortality was significantly higher in pre-Tx ECMO+ versus pre-Tx ECMO- patients (15% vs 5%, P = 0.003), overall graft survival did not differ between groups (79% vs 90% and 61% vs 68% at 1 and 5 years, respectively, P = 0.13). Pretransplant ECMO did not emerge as a risk factor for graft survival in the multivariable analysis. CONCLUSIONS: If applied in selected patients in a high-volume centre, pretransplant ECMO as a bridge to transplantation results in impaired, but still high in-hospital, survival and does not impact graft survival.

  • Ius, F.
  • Natanov, R.
  • Salman, J.
  • Kuehn, C.
  • Sommer, W.
  • Avsar, M.
  • Siemeni, T.
  • Bobylev, D.
  • Poyanmehr, R.
  • Boethig, D.
  • Optenhoefel, J.
  • Schwerk, N.
  • Haverich, A.
  • Warnecke, G.
  • Tudorache, I.

Keywords

  • Adult
  • *Extracorporeal Membrane Oxygenation/adverse effects/mortality/statistics &
  • numerical data
  • Female
  • Graft Survival
  • Humans
  • *Lung Transplantation/adverse effects/mortality/statistics & numerical data
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
Publication details
DOI: 10.1093/ejcts/ezy036
Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Pages: 334-340 
Number: 2
Work Type: Original
Location: BREATH
Disease Area: ROR
Partner / Member: MHH
Access-Number: 29444222
See publication on PubMed

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