P8 ECMO bridge to lung transplant in patients with ILD our experience. (12th November 2019)

• Record Type: Journal Article
• Authors: Zych, B; Rosenberg, A; Carby, M; Simon, A; Reed, A; Kewalramai, N
• Is Part Of: Thorax. Volume 74(2019)Supplement 2
• Page Start: A92
• Page End: A92
• Publication Date: 2019-11-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2019-BTSabstracts2019.151
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and objectives: Patients with advanced ILD (Interstitial Lung Disease) have a narrow window when they can be successfully transplanted. The use of ECMO (Extracorporeal membrane Oxygenation) pretransplant has traditionally been associated with poor posttransplant outcomes. Advances in extracorporeal technology, patients election, and management during ECMO support have led to improved outcomes in carefully selected transplant candidates. 1 Bridge to transplant (BTT) strategies aim to support deteriorating patients until organs are available. The use of ECMO BTT has become more common internationally. We report our experience in single UK centre. Methods: We collected data from patients with ILD who required ECMO BTT between January 2017 to June 2019. Results: In total 9 ILD patients required ECMO as BTT in this period. 3 of them were females and 6 were males. 3 were below 40 years of age and 6 were above 40 years of age. Out of the 9 patients, 4 successfully underwent Lung Transplant and are still alive. 4 were removed from the transplant list when the clinical teams agreed that a point of futility had been reached and the patient was no longer likely to survive transplant. One patient recovered and ECMO was successfully removed. Conclusions: ECMO as BTT can be successful in carefully selected patients. Our centre has the largest cohort of ILD patients who have attempted BTT. Many ILD patients die on the transplant list due to lack of availability of suitable organs. Successful ECMO bridge to transplant remains challenging, highlighting the need for both careful patient selection and anticipatory planning for potentially difficult end-of-life scenarios. Appropriate patient selection and timing of ECMO initiation remain crucial aspects of achieving success with ECMO as BTT. Reference: George PM, Patterson CM, Reed AK, Thillai M. Lung transplantation foridiopathic pulmonary fibrosis. Lancet Respir Med 2019 Mar;7(3):271–282. Cypel M, Keshavjee S. Extracorporeal life support as a bridge to lung transplantation. Clin Chest Med 2011;32:245–51.