Association between Pre-Transplant Allosensitization by ECMO Bridging and Adverse Postoperative Outcome of Lung Transplantation

Abstract

Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation has raised concerns because it can induce pre-transplant allosensitization. Panel reactive antibody (PRA) or human leukocyte antigen (HLA) are examined for confirm pre-transplant sensitization since they are known to be associated with higher occurrence of adverse outcomes such as primary graft dysfunction (PGD), acute rejection and mortality. We examined the prevalence of sensitization in ECMO bridging and evaluated its impact on outcomes of lung transplantation. A single-center retrospective analysis was conducted. We include 211 patients who received a bilateral lung transplantation between January 2013 and June 2019. We defined sensitization either by high PRA (>50%) and/or high mean fluorescence intensity (MFI) (≥5000). Pre-transplant ECMO support was conducted in 64 patients (30.3%). Level of class I PRA was 12.3% and class II was 14.0% in ECMO group while 9.2% and 13.0% in the other group. Number of patients with class I and/or class II PRA greater than 50% was not significantly different between two groups (10 patients, 15.6% in ECMO group, 22 patients, 15.0% in non-ECMO group, p = 0.902). Number of patients with MFI higher than 5000 was also not significantly different (12 patients, 18.8% in ECMO, 24 patients, 26.6% in non-ECMO, p = 0.695). Prevalence of grade 3 PGD at post-operative 72 hours was slightly higher in ECMO group, but it was also not statistically different (18, 28.1% in ECMO group and 24, 16.3% in non-ECMO group, p = 0.061). Acute rejection, chronic lung allograft dysfunction (CLAD), and overall mortality were not significantly different. On multivariable logistic regression, sensitization and grade 3 PGD were not associated with ECMO bridging. Our report demonstrates the possible connection among pre-operative ECMO support, pre-transplant sensitization, and PGD. However, pre-transplant ECMO bridging is not seemed to be risk factors for pre-transplant sensitization nor PGD. Pre-transplant allosensitization might not adversely affect outcomes after lung transplantation.