Grewal Harpreet Singh, Benvenuto Luke, Laothamatas Kemarut, Dimango Angela, Robbins Hilary, Shah Lori, Magda Gabriela, Shreenidhi Ritesh, Dahiya Sneha, Costa Joseph, Stanifer Bryan, Sonett Joshua, D'Ovidio Frank, Lemaitre Philippe, Arcasoy Selim
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY.
Master of Science in Business Analytics, Columbia University, New York, NY.
JTCVS Open. 2025 Mar 28;25:466-473. doi: 10.1016/j.xjon.2025.03.012. eCollection 2025 Jun.
The use of pretransplant extracorporeal membrane oxygenation (ECMO) continues to increase. In the most recent Scientific Registry for Transplant Recipients, 11% of listed candidates for lung transplantation were on ECMO. We evaluated the impact of the duration of ECMO bridge to transplantation on posttransplant outcomes using United Network for Organ Sharing data.
We performed a retrospective cohort study from January 1, 2015, to December 31, 2019, to include pre-COVID-19 pandemic data. Patients were grouped into quartiles on the basis of duration of ECMO support (<4, 4-8, 9-17, and >17 days). The primary outcome was survival at 1 year after transplantation. Secondary outcomes included length of stay from transplant to discharge, 1-month survival, 6-month survival.
In total, 489 patients were analyzed. Median age decreased over the quartiles (quartile 1 age 55 vs quartile 4 age 37; < .001). The proportion of patients who were ambulatory on ECMO support increased over the quartiles (quartile 1 was 23.85% vs quartile 4 was 63.87%; < .001). Survival at 1 year was not different among the quartiles after adjusting for lung allocation score, body mass index, gender, ambulatory status, type of lung transplant, and creatinine. Six-month survival was reduced in the patients on prolonged ECMO support (quartiles 3 and 4). Ambulatory status, creatinine, and body mass index were significant contributors to survival at 1 year in the adjusted analysis.
Duration of pretransplant ECMO bridge to transplantation appears to impact 6-month survival in patients who were on ECMO for 9 days or longer, but duration of ECMO support does not appear to negatively impact postlung transplant survival during the first year or length of stay from transplant to discharge.
移植前体外膜肺氧合（ECMO）的使用持续增加。在最新的移植受者科学登记处，11%的肺移植登记候选人正在接受ECMO治疗。我们使用器官共享联合网络的数据评估了ECMO过渡到移植的持续时间对移植后结局的影响。
我们进行了一项回顾性队列研究，时间范围为2015年1月1日至2019年12月31日，纳入新冠疫情大流行前的数据。根据ECMO支持的持续时间（<4天、4 - 8天、9 - 17天和>17天）将患者分为四分位数组。主要结局是移植后1年的生存率。次要结局包括从移植到出院的住院时间、1个月生存率、6个月生存率。
总共分析了489例患者。四分位数组中患者的年龄中位数逐渐降低（第一四分位数组年龄为55岁，第四四分位数组年龄为37岁；P <.001）。接受ECMO支持时能够活动的患者比例在四分位数组中逐渐增加（第一四分位数组为23.85%，第四四分位数组为63.87%；P <.001）。在调整肺分配评分、体重指数、性别、活动状态、肺移植类型和肌酐后，四分位数组之间1年生存率没有差异。接受长时间ECMO支持的患者（第三和第四四分位数组）6个月生存率降低。在调整分析中，活动状态、肌酐和体重指数是1年生存率的重要影响因素。
移植前ECMO过渡到移植的持续时间似乎会影响接受ECMO治疗9天或更长时间患者的6个月生存率，但ECMO支持的持续时间似乎不会对肺移植后第一年的生存率或从移植到出院的住院时间产生负面影响。
