Mortality after Lung Transplantation for Children Bridged with Extracorporeal Membrane Oxygenation

Cystic fibrosis year in review 2021

“…There was no difference in likelihood to receive lung transplantation while on ECMO for PwCF compared to those with obstructive lung disease, or interstitial lung disease. A separate analysis of UNOS, evaluated 68 patients in a younger cohort (under 20 years of age), over 2004 -2019, and found 42.7% of those requiring ECMO as a bridge to transplantation, had CF 61 . In this younger cohort, use of ECMO as a bridge had 2-3 times odds of mortality prior to discharge compared to those on a ventilator.…”

Bridging Children to Lung Transplantation Using Extracorporeal Membrane Oxygenation

“…In this issue of AnnalsATS , Thompson and colleagues (pp. 415–423 ) report the outcomes of children who received ECMO as a bridge to lung transplant ( 7 ). The study was a retrospective analysis of the OPTN registry that reported 1- and 5-year survival for children <21 years old who received a lung transplant between 2004 and 2019 ( 7 ).…”

“…415–423 ) report the outcomes of children who received ECMO as a bridge to lung transplant ( 7 ). The study was a retrospective analysis of the OPTN registry that reported 1- and 5-year survival for children <21 years old who received a lung transplant between 2004 and 2019 ( 7 ). Outcomes were compared among three groups: those bridged to lung transplant with ECMO support (with or without mechanical ventilation), mechanical ventilation (without ECMO), or neither ( 7 ).…”

“…The authors reported that, although at hospital discharge patients bridged to lung transplant with ECMO had an associated increased risk of mortality, long-term survival of children receiving ECMO as a bridge to lung transplant was comparable to those who required neither ECMO nor ventilatory support ( 7 ). The 1-month Kaplan-Meier estimated survival after lung transplant was 88% (95% confidence interval [CI], 78–94%) for children bridged to transplant with ECMO compared with 97% (95% CI, 96–98%) among children not requiring ECMO or mechanical ventilation.…”

“…Future work with combined lung transplant and ECMO registries may help address the urgent need to identify candidates who are most likely to be successfully bridged to transplant. Regarding candidacy, only 10% (7/68) with ECMO support as a bridge to lung transplant had pneumonia or acute respiratory distress syndrome (ARDS) ( 7 ), but this may become increasingly relevant as a result of the coronavirus disease (COVID-19) pandemic. There have been early reports in COVID-19 of using ECMO as a bridge to lung transplant ( 12 ).…”