Impact of Age on Survival in Patients Bridged to Lung Transplantation with Extracorporeal Membrane Oxygenation (ECMO)

Abstract

The purpose of this study was to examine outcomes and survival with extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LT) stratified by recipient age. The United Network for Organ Sharing database was analyzed for patients aged ≥18 years who were bridged to a lung transplant with an ECMO between 2005 to 2018. Recipients were categorized into 3 age groups based on age at the time of listing. Baseline clinical characteristics and post-transplant in-hospital outcomes were compared among 3 age groups. The Kaplan Meier survival curves and the log rank test were used to estimate and compare survival among patient groups. During the study period, a total of 275 patients were bridged to LT with an ECMO. There were 154 (56%) patients aged < 50 years, 84 (31%) were 50-60 and 37 (13.5%) of them were >60 years. Mean wait-list time was comparable among patient groups (17 vs.18. vs.18 days, p =0.981). Compared to the younger patients, patients > 60 years had a higher incidence of tobacco usage, history of cardiac surgery and more likely to be transplanted for IPF, with a single lung. Mean LAS scores were lower in the >60year group than the other two patient groups. (<50yrs: 78 vs 50-60yrs: 84% vs. >60yrs. 73; p = 0.011). There was no difference in post-transplant in-hospital outcomes. Post-transplant survival at 1-year was significantly lower in the older age groups. (<50yrs: 87% vs 50-60yrs: 74% vs. >60yrs. 61%; Log rank test: p = 0.021). Post-transplant survival after ECMO as a bridge to LT is significantly reduced in patients older than 60. Age should be strongly considered in the deciding whether to bridge patients to LT with ECMO.