A Direct Heart-Transplantation Strategy in Selected Patients on Extra-Corporeal Membrane Oxygenation Achieved Favorable Post-Transplant Outcomes

Purpose To analyze post-heart transplantation (HTx) outcomes in selected patients on ECMO support. Our local strategy is to transplant ECMO-patients without mechanical ventilation or kidney failure (creatinine clearance ≤ 30 mL/min or dialysis). In addition, specific pre-transplant (intra-aortic balloon pump, reperfusion canula) and post-transplant strategies (maintaining ECMO after HTx) were applied. Methods We performed a restrospective study in a high ECMO and HTx volume center. We included all-consecutive patients with a first non-combined HTx performed between 2012 and 2016. We aimed to compare outcomes between patients with or without ECMO support at the time of HTx. The primary outcome was all-cause mortality after HTx. Secondary outcomes included death-censored rejection-free survival and complications of ECMO (infection, vascular complications). Risk factors for death were identified using Cox proportional hazard model. Results We analyzed 415 patients, including 118 patients (28.4%) under ECMO support at the time of HTx. Median follow-up post-transplant was 20.7 months. Median time on ECMO before HTx was 9 days (IQR = 5-15). Post-transplant survival in ECMO-patients was not significantly different from non-ECMO patients (see figure, p=0.12). In the overall cohort, only recipient age (HR = 1.22 per 10-year increment), recipient BMI (HR = 3.93 for BMI Conclusion A direct heart transplantation strategy in selected patients on ECMO support achieved favorable post-transplant outcomes.