Mid-Term Results of Lung Transplantation (LTx) after Bridging with Extracorporeal Membrane Oxygenation - Influence of Concomitant Invasive Mechanical Ventilation (iMV)

Purpose ECMO as a bridge to LTx became over the last decade a standard approach in rapidly deteriorating patients in selected centres. Recent analysis revealed that pre-transplant iMV rather than ECMO by itself is an independent risk factor. In this study we compare our cohort of mechanically and self- ventilated patients bridged to LTx with ECMO. Methods Between 07.2011 and 10.2018 32 patients underwent first time LTx being on ECMO support preoperatively due to a rapidly progressing exacerbation. They were divided into 2 groups: 1-mechanically ventilated (N-11) and 2-self-ventilated (N-21) for more than 50% of support duration. Recipients’ and donors’ demographics, peri-operative variables and outcomes were compared. Survival estimate using a Kaplan-Meier method was performed from the day of LTx. Results Donors’ and recipients’ characteristics and intra-operative variables were comparable except for duration of preoperative iMV during ECMO support (mean±SD): group 1 vs. 2 - 14.5±15 vs. 2.4±6 days (p=0.003). There were no differences observed in recipients’ post-transplant duration of iMV, prevalence of grade 3 primary graft dysfunction, ECMO use, intensive care unit length of stay (LOS) and prevalence of any episode of acute rejection (AR). Hospital LOS was shorter in group 1: 23.5±15.5 vs. 43.6±29.6 days (p=0.047). Significantly higher rate of chronic lung allograft dysfunction (CLAD) was observed in group 1: 52 vs. 6.2 % (p=0.028). Estimated three-month, 1-year and 5-year survival was significantly worse in ventilated patients: 36.4 vs. 84.3; 36.4 vs. 84.3 and 36.4 vs. 63.2 % (Log rank p= 0.001). Conclusion Early implantation of ECMO in rapidly deteriorating patients on transplant waiting list facilitates a bridging without invasive mechanical ventilation. Lung transplantation in self ventilated patients bridged to Ltx with ECMO is safe and effective strategy providing an excellent early and mid-term results.