Abstract
BackgroundAlthough bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear.MethodsWe retrospectively reviewed medical records of adult patients who underwent lung or heart-lung transplantation in our institution between January 2008 and December 2018. Data were compared in patients who did (n = 41; BTT) and did not (n = 36; non-BTT) require pre-transplant ECMO support. Data were also compared in patients who underwent short-term (<14 days; n = 21; ST-BTT) and long-term (≥14 days; n = 20; LT-BTT) BTTs.ResultsAmong 77 patients included, 51 (66.2%) were male and median age was 53 years. The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7–19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR, 31–49 in BTT group vs. median, 12; IQR, 7–19 in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST- and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group. In age and sex adjusted model, the LT-BTT was an independent risk factor for 1-year post-transplant mortality (hazard ratio, 3.019; 95% confidence interval, 1.119–8.146; p = 0.029), whereas the ST-BTT was not.ConclusionsDespite the severe illness, the BTT group showed favorable post-transplantation outcomes, particularly those bridged for less than 14 days.
Highlights
Lung transplantation is a standard of care for patients with various non-malignant end-stage lung diseases [1]
Simplified acute physiologic score II was significantly higher in the bridge to lung transplantation (BTT) group, 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups
Comparison of ST- and LTBTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group
Summary
Lung transplantation is a standard of care for patients with various non-malignant end-stage lung diseases [1]. Waiting list mortality rates are as high as 121.8 deaths per 100 waitlist-years, with mortality rates being high in patients with high severity indices [2] These findings suggest that a conventional bridging strategy, consisting of invasive mechanical ventilation alone, may be suboptimal in severely ill patients. Rather, these patients may require additional cardiopulmonary support, such as extracorporeal membrane oxygenation (ECMO), while awaiting lung transplantation [3,4,5]. Bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear
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