Contemporary look at extracorporeal membrane oxygenation as a bridge to reoperative lung transplantation in the United States – a retrospective study. (12th May 2020)

• Record Type: Journal Article
• Authors: Hayanga, Jeremiah William Awori; Hayanga, Heather K.; Fugett, James H.; Musgrove, Kelsey A.; Abbas, Ghulam; Ensor, Christopher R.; Badhwar, Vinay; Shigemura, Norihisa
• Is Part Of: Transplant international. Volume 33:Number 8(2020)
• Page Start: 895
• Page End: 901
• Publication Date: 2020-05-12
• Subjects: complications -- extracorporeal membrane oxygenation -- lung clinical -- lung transplantation -- outcome -- surgery; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13617
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: The purpose of this study was to examine the influence of extracorporeal membrane oxygenation (ECMO) as a bridge to reoperative lung transplantation (LT) on outcomes and survival. A total of 1960 LT recipients transplanted a second time between 2005 and 2017 were analyzed using the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN). Of these recipients, 99 needed ECMO as a bridge to reoperative LT. Mean age was 50 ± 14 years, 47% were females, and the group with ECMO was younger [42 (30–59) vs. 55 (40–62) years]. In both univariate and multivariable analyses (adjusting for age and gender), the ECMO group had greater incidence of prolonged ventilation >48 h (83% vs. 40%, P < 0.001) and in‐hospital dialysis (27% vs. 7%, P < 0.001). There were no differences in incidence of acute rejection (15% vs. 11%, P = 0.205), airway dehiscence (4% vs. 2%, P = 0.083), stroke (3% vs. 2%, P = 0.731), or reintubation (20% vs. 20%, P = 0.998). Kaplan–Meier survival analysis showed the ECMO group had reduced 1‐year survival (66.6% vs. 83.0%, P < 0.001). After covariate adjustment, the ECMO group only had increased risk for 1‐year mortality in the 2005–2011 era (HR = 2.57, 95% CI = 1.45–4.57, P = 0.001). For patients who require reoperative LT, bridging with ECMO was historically a significant predictor of poor outcome, but may be improving in recent years.