Outcomes with venoarterial vs venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation in interstitial lung disease.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.