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Improving Outcomes in Bridge-to-Transplant

Extended Extracorporeal Membrane Oxygenation Support to Obtain Optimal Donor Lungs for Marginal Recipients

Langer, Frank*; Aliyev, Parviz*; Schäfers, Hans-Joachim*; Trudzinski, Franziska C.; Seiler, Frederik; Bals, Robert; Wilkens, Heinrike; Lepper, Philipp M.

doi: 10.1097/MAT.0000000000000843
Pulmonary
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The use of extracorporeal membrane oxygenation (ECMO) as bridge-to-lung transplantation has been discussed controversially because of discouraging results. We report our experience with this challenging strategy. This retrospective investigation includes all consecutive lung transplantations in our center between January 2012 and July 2017 (n = 88, median Lung Allocation Score 66). Data of patients on ECMO bridge-to-transplant (n = 34) were compared with patients without such support (n = 54). Patients requiring ECMO support underwent lung transplantation after median bridging time of 29 days (range, 0–129 days). Survival was superior if transplantation was performed within 29 days of ECMO (p = 0.04). Donor age and oxygenation (pO2/FiO2) were similar in recipients with ECMO (42.3 ± 15.2 years, 444.5 ± 68.9 mm·Hg) or without ECMO (43.1 ± 13.9 years, 454.5 ± 73.4 mm·Hg). Four patients required postoperative ECMO support >1 day. Survival at 1 year and 3 years was similar in recipients with ECMO support (79%, 63%) or without ECMO support (86%, 71%). Successful lung transplantation after ECMO as bridge-to-transplant can be achieved, even in patients with prolonged support times. Bridging time of less than 30 days, however, is crucial for success. Extracorporeal membrane oxygenation expertise and donor organ quality may be important factors for favorable outcome.

*Department of Thoracic and Cardiovascular Surgery

Department of Internal Medicine V, Pneumology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar, Germany.

Submitted for consideration November 2017; accepted for publication in revised form May 2018.

Disclosure: The authors have no conflicts of interest to report.

This work was supported by departmental funding.

Correspondence: Frank Langer, Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, 66424 Homburg/Saar, Germany. Email: frank.langer@uks.eu.

Copyright © 2019 by the American Society for Artificial Internal Organs