Abstract Rationale Lung transplantation remains the definitive treatment for advanced cystic fibrosis (CF) lung disease. However, bridging with extracorporeal membrane oxygenation (ECMO) is increasingly utilized for patients with acute respiratory decompensation while awaiting transplant.1 Data describing outcomes of CF recipients requiring ECMO at the time of transplantation remain limited. Methods A retrospective review was conducted of people with CF (pwCF) undergoing double lung transplantation at a tertiary center between March 2005 and December 2022. Patients undergoing multiorgan or redo transplantation or with Burkholderia infection were excluded. For a random subset of all the CF recipients (n = 51), demographic, pretransplant variables, and postoperative outcomes were compared between those bridged with ECMO at the time of transplant and those who were not. Kaplan-Meier analysis assessed post-transplant survival. Continuous variables were summarized as medians (interquartile ranges) and compared using the Mann-Whitney U test; categorical variables were compared using Fisher’s exact test. Results This study evaluated the survival outcomes of 124 pwCF who received lung transplants. Median posttransplant survival was 14.7 years for ECMO recipients versus 9.4 years for non-ECMO recipients (log-rank p = 0.28; hazard ratio 0.73). Among 51 recipients, 11 required ECMO (median age 30 years IQR, 28-32; 6 women 55%). ECMO recipients had higher lung allocation scores (88.7 vs 40.4; p 0.05) but similar pretransplant BMI (20.5 vs 20.1 kg/m²; p = 0.84), forced expiratory volume (FEV1) (22% vs 22% predicted; p = 0.45), creatinine (0.9 vs 0.7 mg/dL; p = 0.18), median supplemental oxygen requirement (4.0 vs 3.0 L/min; p = 0.22), and LVEF (60% vs 55%; p = 0.06). ECMO support included dual veno-venous (64%), single veno-venous (27%), and veno-arterial (9%) configurations, with median duration 96 hours (IQR, 12-312) after median ventilation of 168 hours (IQR, 24-936). Postoperatively, ECMO recipients had longer hospital stays (31.0 vs 22.8 days; p = 0.23) and more frequently required tracheostomy (82% vs 25%; p 0.05). Best posttransplant FEV1 % predicted was similar (96.5% vs 93.0%; p = 0.99). Conclusions Despite greater illness severity at transplantation, pwCF bridged with ECMO demonstrated similar post-transplant survival and lung function to those not requiring ECMO. These results suggest that ECMO can provide an effective bridge to transplantation without compromising long-term outcomes. Reference Rando HJ, Fanning JP, Cho SM, et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation: Practice patterns and patient outcomes. J Heart Lung Transplant. 2024;43(1):77-84. doi:10.1016/j.healun.2023.06.016 This abstract is funded by: None
Martinez et al. (Fri,) studied this question.