Extracorporeal Membrane Oxygenation during Lung Transplantation and Long-Term Graft Function: Results from a 9-Year Single-Center Experience

Abstract

In lung transplantation, intraoperative extracorporeal membrane oxygenation (ECMO) allows transplanting high-risk patients, such as those with idiopathic pulmonary arterial hypertension (iPAH). However, early postoperative course is more complicated in patients with than without ECMO, with higher prevalence of severe primary graft dysfunction (PGD), a risk factor for chronic lung allograft dysfunction (CLAD). Aim of this retrospective study was to test the hypothesis if the worse early postoperative course in ECMO patients translates in a worse long-term graft function too. Our institutional lung database was searched for patients who were transplanted with intraoperative ECMO between January 2010 and September 2019. Perioperative and follow-up results were compared between patients transplanted with ECMO and without ECMO. Follow-up amounted to a median of 41 (19-71) months. During the study period, among the 1,189 lung-transplanted patients, 316 (27%) patients required ECMO and the remaining 848 (71%) patients did not. Twenty-four (2%) patients requiring intraoperative cardiopulmonary bypass (CPB) support were excluded. ECMO patients showed a higher pre-transplant surgical risk profile (iPAH, 23% vs 0%, p<0.001; lung fibrosis, 42% vs 28%, p<0.001; ECMO as bridge to transplantation, 25% vs 0, p<0.001; median LAS score 42.2 vs 34.8, p<0.001) and a more complicated early postoperative course (PGD grade 3 at 72 hours, 15% vs. 1%, p<0.001; in-hospital mortality, 11% vs 2%, p<0.001) than patients without ECMO. While graft survival was worse in patients with than in patients without ECMO, freedom from CLAD, biopsy-confirmed rejection and pulsed-steroid therapy did not differ between groups (figure 1). The worse graft survival in ECMO patients was driven by a higher in-hospital mortality, but graft function at follow-up did not differ in discharged patients transplanted with and without ECMO.