Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality

Abstract

Purpose of Review We examined data from the last 5 years describing extracorporeal life support (ECLS) as a bridge to lung transplantation. We assessed predictors of survival to transplantation and post-transplant mortality. Recent Findings The number of lung transplants performed worldwide is increasing. This is accompanied by an increase in the type of patients being transplanted, including sicker patients with more advanced disease. Consequently, there is an increase in the need for bridging strategies, with varying success. Several predictors of failure have been identified. Major risk factors include retransplantation, other organ dysfunction, and deconditioning. Summary ECLS is a risky strategy but necessary for patients who would otherwise die if not bridged to transplantation. The presence of predictors for failure is not a contraindication for bridging. However, major risk factors should be approached cautiously. Other, more minor risk factors may be considered acceptable. More importantly, the strategy should be individualized for each patient to achieve the best possible outcomes.

Experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: intraoperative indicators

“…Hemodynamic instability caused by anesthesia induction and surgical manipulations can be balanced with ECMO support. Contrary to the literature [14], the indications for transplantation were not associated with the use of ECMO in this study. This may be because the patient population is relatively small.…”

Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation

“…Although worsening of illness during long-term BTT may be associated with worse post-transplant outcomes [20], our study found that SAPS II at the time of transplantation were comparable in the groups. Other risk factors such as infection, deconditioning, and ECMO complications also may contribute to the poor prognosis in the long-term BTT group [29]. In this study, interestingly, the requirement for V-A ECMO was more frequent in the LT-BTT group.…”

Extracorporeal Membrane Oxygenation Support for Interstitial Lung Disease in Idiopathic Inflammatory Myopathies: An ELSO Registry Analysis

“…4 However, survival in this population is still lower than patients supported as BTT for all-cause lung transplantation. 6 Pulmonary fibrosis was common in our BTT group, indicating these patients may have had end-stage lung disease and were previously listed for transplant before offering ECMO support. In addition, transplanted patients did not receive steroids, had no opportunistic infections, and had decreased ventilatory times.…”

“…4 However, survival in this population is still lower than patients supported as BTT for all-cause lung transplantation. 6 Pulmonary fibrosis was common in our BTT Number of patients with data in each category is indicated with (n = x) if there is missing data.…”