Balasubramanian Prasanth, Franco Pablo Moreno, Chaudhary Sanjay, Alvarez Francisco G, Baz Maher, Shah Sadia Z, Alomari Mohammad, Bongu Rohan, Bhattacharrya Anirban, Sanghavi Devang, Kiley Sean, Martin Archer K, Matos Nikki L, Haney John C, Makey Ian, Thomas Mathew, Guru Pramod K, Bag Remzi
Division of Lung Failure and Transplant, Department of Transplantation, Mayo Clinic, Jacksonville, Florida.
Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida.
JHLT Open. 2025 May 13;9:100287. doi: 10.1016/j.jhlto.2025.100287. eCollection 2025 Aug.
Evidence on outcomes associated with venoarterial (VA) versus venovenous (VV) of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx) in interstitial lung disease (ILD) is limited.
Using the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) registry, we conducted a retrospective cohort study on ILD patients bridged with ECMO for LTx. Outcomes by cannulation type (VV vs VA) were analyzed, with 1:1 propensity matching to reduce selection bias.
Among 1,551 patients, 1,236 (79.7%) were on VV ECMO and 315 (20.3%) on VA ECMO. Delisting due to death or deterioration was higher with VA ECMO in both the overall (41% vs 27%, < 0.001) and matched (41% vs 30%, = 0.003) cohorts. VA ECMO was associated with higher 1-year post-transplant mortality in the overall cohort (33% vs 24%, < 0.001), though not statistically significant in the matched cohort (33% vs 24%, = 0.059). Multivariate Cox-proportional hazard regression analysis showed no significant difference in 1-year post-transplant mortality with VA ECMO in the overall (adjusted Hazard Ratio (aHR) 1.01 (95% confidence interval, CI 0.65-1.60, > 0.9)) and matched (aHR 1.24, 95% CI 0.78-1.97, = 0.4) cohorts, compared to VV ECMO. However, the VA ECMO had higher 1-year post-transplant mortality in the setting of COVID-19 associated pulmonary fibrosis (aHR 7.12, 95% CI 1.9-26.6, = 0.003).
VV ECMO was associated with a more successful bridge to LTx than VA ECMO. Adjusted post-transplant outcomes were comparable. Prospective studies are warranted to explore outcome differences by cannulation strategy in ILD.
关于体外膜肺氧合（ECMO）作为间质性肺疾病（ILD）肺移植（LTx）桥梁时，静脉 - 动脉（VA）与静脉 - 静脉（VV）模式相关结局的证据有限。
利用器官共享联合网络（UNOS）的标准移植分析与研究（STAR）登记处的数据，我们对接受ECMO作为LTx桥梁的ILD患者进行了一项回顾性队列研究。分析了插管类型（VV与VA）的结局，并采用1:1倾向匹配以减少选择偏倚。
在1551例患者中，1236例（79.7%）接受VV ECMO，315例（20.3%）接受VA ECMO。在总体队列（41%对27%，P<0.001）和匹配队列（41%对30%，P = 0.003）中，VA ECMO因死亡或病情恶化而被取消移植资格的比例更高。在总体队列中，VA ECMO与移植后1年更高的死亡率相关（33%对24%，P<0.001），尽管在匹配队列中无统计学意义（33%对24%，P = 0.059）。多因素Cox比例风险回归分析显示，在总体队列（调整后风险比（aHR）1.01（95%置信区间，CI 0.65 - 1.60，P>0.9））和匹配队列（aHR 1.24，95% CI 0.78 - 1.97，P = 0.4）中，与VV ECMO相比，VA ECMO在移植后1年的死亡率无显著差异。然而，在2019冠状病毒病相关肺纤维化的情况下，VA ECMO的移植后1年死亡率更高（aHR 7.12，95% CI 1.9 - 26.6，P = 0.003）。
与VA ECMO相比，VV ECMO作为LTx的桥梁更成功。调整后的移植后结局相当。有必要进行前瞻性研究以探讨ILD中插管策略对结局的差异。
