Extracorporeal membrane oxygenation as a bridge to lung transplantation in a Turkish lung transplantation program: our initial experience

Abstract

Lung transplantation is a life-saving treatment for patients with end-stage lung disease. Although the number of lung transplants has increased over the years, the number of available donor lungs has not increased at the same rate, leading to the death of transplant candidates on waiting lists. In this paper, we presented our initial experience with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. Between December 2016 and August 2018, we retrospectively reviewed the use of ECMO as a bridge to lung transplantation. Thirteen patients underwent preparative ECMO for bridging to lung transplantation, and seven patients successfully underwent bridging to lung transplantation. The average age of the patients was 45.7 years (range, 19-62 years). The ECMO support period lasted 3-55 days (mean, 18.7 days; median, 13 days). In seven patients, bridging to lung transplantation was performed successfully. The mean age of patients was 49.8 years (range 42-62). Bridging time was 3-55 days (mean, 19 days; median, 13 days). Two patients died in the early postoperative period. Five patients survived until discharge from the hospital. One-year survival was achieved in four patients. ECMO can be used safely for a long time to meet the physiological needs of critically ill patients. The use of ECMO as a bridge to lung transplantation is an acceptable treatment option to reduce the number of deaths on the waiting list. Despite the successful results achieved, this approach still involves risks and complications.

Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

“…Bridge to transplant appears to still be a viable option within smaller centers, but the results are subject to more variability. In one smaller study of the thirteen patients who received preparatory ECMO, seven were successfully bridged to transplant, but only four survived past 1 year [ 9 ].…”

“…Several studies have highlighted the advantage high-volume centers appear to have relative to lower volume ones [ 3 , 9 , 10 ]. Hayes et al specifically analyzed for this very effect, finding a discrepancy in outcomes when examining the volume of a center [ 10 ].…”