Purpose Extracorporeal membrane oxygenation (ECMO) can be used in profound respiratory failure as a bridge to lung transplantation (BLT).Previous analysis of our limited historical series demonstrated higher early mortality but acceptable mid-term patient outcomes. We present here our recent BLT experience with focus on patient outcomes, allograft function and health-related quality of life (HRQOL). Methods and Materials From March 2005 to October 2012, 822 Lung Transplants (LT) were performed at our institution. Forty seven patients (pts.) were supported with ECMO as BLT.Diagnoses included Idiopathic Pulmonary Fibrosis (n =15), Cystic fibrosis (n = 13), Pulmonary Hypertension (n = 3), Scleroderma (n=3), redo LT (n=2) and other (n = 11). Eleven pts. (23%) died during support and thirty-six pts. were transplanted. The age of LT recipients was 43.3±15 yrs and 19/36 pts.were male. Double LT was performed in 29 pts. and lobar LT in 7. Veno-venous (VV) and veno-arterial (VA) ECMO were implanted in ten and twenty-six pts., respectively. Median duration of support was 4 days (range 1-11 days) and 13 days (range 1-56days ) in pts. with VA and VV ECMO. HRQOL was assessed using SCL-90-R and SF-36 forms at 6 months. Results Thirty-day, 1-year, and 4-year survival for transplanted patients was 100 %, 88%, and 88% and 96%, 83%, and 61% for the non-supported patients (p = 0.260,0.62 and 0.15). Survival did not differ according to ECMO support type (p=0.86). In the pts. with ECMO as BLT the average ICU and hospital length of stay was 19±11 and 42 ±20 days. At 1- year follow-up, FEV1 was 2.26±0.6 L and FVC 2.72±0.8 L. At 6 months, 73 % and 64 % of pts. evaluated were free of clinically significant distress due to anxiety or depression with 42% and 73 % of pts. reporting better physiscal and mental QOL scores than the general US adult population. Conclusions Contemporary Lung Transplantation outcomes with the use of ECMO as a BLT are satisfactory and associated with adequate patient survival, allograft function and HRQOL, despite longer ICU and hospital stay.