Long-Term Outcomes of ECMO Post-Heart Transplant

Abstract

<h3>Purpose</h3> Extracorporeal membrane oxygenation (ECMO) can be used to rescue patients with graft dysfunction after heart transplant (HT) and is associated with high early mortality. Less is known about long-term prognosis after post-HT ECMO. The purpose of this study was to analyze the incidence and outcomes for post-HT ECMO at a high-volume pediatric heart transplant center. <h3>Methods</h3> Retrospective review of all patients who underwent HT at Lucile Packard Children's Hospital Stanford from 1/2009 - 9/2021. Patient characteristics and risk factors were analyzed. Early Graft Failure (EGF) was defined as ECMO cannulation within 24 hours of transplant. Late Early Graft Failure (LEGF) was defined as ECMO cannulation between 1-14 days. All other patients were classified as Late Graft Failure (LGF). Long-term graft survival was defined as survival > 12 months after first ECMO course. <h3>Results</h3> Of 254 transplants during the study period, 21 patients (8.3%) required ECMO following HT. Indication for ECMO was confirmed or suspected rejection in 9 (42%), primary graft dysfunction in 6 (29%), and sudden cardiac arrest in 2 (9.5%). Of the 21 patients, 13 (62%) survived their ECMO course but only 7 (33%) remain alive with a median follow-up of 3.5 years (range 0.5-11 years). In the 6 (29%) patients who survived ECMO but subsequently died, median time to death was 62 days (range 8-445 days). There were 8 patients with EGF, 3 patients with LEGF, and 10 with LGF. LGF occurred at a median of 2.7 years (range 0.7-7 years) post HT. Survival to hospital discharge was 62.5% with EGF, 0% for LEGF, and 50% for LGF. Of the 5 patients with LGF surviving to hospital discharge, 2 subsequently died, 1 was retransplanted and 2 remain alive. Long term graft survival for EGF was 50% versus 30% for LGF. <h3>Conclusion</h3> Early and late post-transplant ECMO has a high in-hospital mortality rate. Patients who undergo ECMO for late graft failure have worse long-term outcomes than those who undergo ECMO for early graft failure. Rescue graft support for late early graft failure was universally unsuccessful.