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Building bridges: Extracorporeal membrane oxygenation versus mechanical ventilation as bridge to lung transplant-A
Koray N Potel1, Omar Atef Abdelhamid Mahmoud1, Sean H Nguyen1
1Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
Objective:
In lung transplantation, the use of extracorporeal membrane oxygenation as a bridge to transplant has become increasingly common compared with pretransplant mechanical ventilation. In patients who can be supported with pretransplant mechanical ventilation, the benefit of extracorporeal membrane oxygenation over pretransplant mechanical ventilation is unclear. We compared the long-term survival of patients who underwent lung transplant after bridge to transplant with pretransplant mechanical ventilation versus extracorporeal membrane oxygenation.
Methods:
The United Network for Organ Sharing database was used to identify adult lung transplant recipients between January 1, 2005, and March 31, 2025. Of the 40,305 patients identified, 925 were on extracorporeal membrane oxygenation, 1144 were on pretransplant mechanical ventilation, and 1063 were on both at the time of transplant. Demographics, outcomes, and survival were compared among those groups. A Cox proportional hazard multivariable regression model was used to analyze extracorporeal membrane oxygenation/pretransplant mechanical ventilation-dependent survival, adjusting for 14 patient characteristics.
Results:
Patients on extracorporeal membrane oxygenation + pretransplant mechanical ventilation had the highest need for post-lung transplantation dialysis (18.9% vs 24.2% vs 10.3%, P < .001) and the longest median postoperative inpatient stay (28 vs 34 vs 27 days, P < .001). Patients on pretransplant mechanical ventilation alone had the highest rate of graft rejection at 1 year (19.3% vs 23.2% vs 28.3%, P < .001). There was no difference in 1-year (82% vs 80% vs 79%, P = .26) and 5-year (53% vs 54% vs 50%, P = .28) unadjusted survival. Likewise, there was no difference in adjusted survival at 1 year (P > .2) and 5 years (P > .5).
Conclusions:
Despite a higher rate of graft rejection at 1 year in patients on pretransplant mechanical ventilation, the mode of bridge to lung transplantation does not appear to impact short- or long-term survival.
