Respiratory Failure Treated by ECLS in Previously Unscreened Patients - Is Lung Transplantation Feasible?

Abstract

ECLS is increasingly used to bridge deteriorating candidates to LTx. Most centers would only bridge patients previously approved for Tx and on the waiting list. Our center has accepted to transplant patients supported with ECLS device previously unknown to the transplant team. Unscreened patients on ECLS for respiratory failure were included in this retrospective single-center analysis. Criteria to accept patients for Tx were: preserved kidney and liver function, acceptable muscular reserve, no systemic disorders, no significant CV comorbidities. This group was compared to deteriorating patients on the waiting list and bridged to their Tx. Ninety-six patients were bridged by ECLS to primary LTx between 2005 and 2018. This included 37 (38%) unscreened patients with a median age was 30 years (13-65). The main diagnosis was CF (14, 38%) followed by fibrosis (11, 30%) and ARDS (6, 16%). Median ECLS bridging time was was similar in both groups (5 vs 7 days). Thirty (81%) patients listed during ECLS were intubated prior to implantation of ECLS device. Seven of them (19%) could be weaned from invasive ventilation and could be bridged awake to Tx compared to 17 (32%) patients in the control group. Among the 37 unscreened patients, 13 (35%) were on VA ECMO, 13 (35%) on VV double site ECMO and 7 (19%) on a combination of modalities. 32/37 patients (90%) reached Tx. At 72 hours PGD grade 3 was observed in 2 recipients in the group evaluated during ECLS period compared to 1 recipient in the other group. No differences were found in terms of length of mechanical ventilation after Tx among the two groups: 2 days (1-15) vs 4 days (1-37). One and 5-year survival rate per intention to treat were: 57% vs 64 % and 45% vs 50% (p=0.414), respectively. Long-term results of Tx for previously unscreened patients on ECLS are comparable to ECLS bridged patients already on the waiting list. Our data provide evidence that this group of patients should not be excluded from a life-saving transplantation.