Logo image
Back
Long Term Survival After Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation
Abstract   Peer reviewed

Long Term Survival After Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation

A. Abramov, M. Daniel, J. Song, J. White, P. Cho, D. Telesca and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 510-511
Apr 2026
DOI: https://doi.org/10.1016/j.healun.2026.02.1105

Abstract

Purpose: Extracorporeal membrane oxygenation (ECMO) has evolved as a bridge to lung transplantation (BTT) in acutely ill patients. Despite growing adoption of BTT, optimal patient selection and long-term survival remain unclear. We hypothesized that long-term overall survival of BTT patients would be similar to other lung transplant recipients (LTR). Methods: Retrospective single center cohort study of consecutive LTRs from Jan 2015 to June 2025, comparing outcomes of BTT vs. no BTT. Waitlist removals were queried. Primary outcome was long-term survival to five years. Secondary outcomes included PGD score, mechanical ventilation, ICU and hospital length of stay. Standard descriptive statistics are reported and groups compared; Kaplan Meier and Cox-Proportional Hazard models for time-to-event analysis. Results: 899 patients were included with 93 (10.3%) BTT. ECMO configurations were as follows: VA (n=42, 45%), VV (n=44, 47%) with a median duration of 13 days. BTT patients were younger (55 vs. 62 years old, p <0.001), higher LAS (88 vs. 41, p<0.001), CAS (49 vs. 33, p<0.001), had shorter waitlist times (16 vs. 40d, p<0.001). All patients waitlisted as BTT who were not transplanted died (median 18d). Post-op, BTT patients had higher rates of PGD3 at 72hrs (9.9% vs. 7.3%), need for tracheostomy (43 [51%] vs. 129 [18%], p<0.001), longer ICU (10 vs. 6d, p <0.001) and hospital stays, (18 vs. 14d, p<0.001). Overall survival at one year (89% vs 91%, p=0.8) and long-term overall survival at five years were similar (p=0.13). In a multivariable Cox PH model, longer ischemia time, PGD3 at 72hr, single lung transplant, and post-op ECMO support were associated with decreased overall survival. Conclusion: Properly selected BTT patients, when compared to other LTRs, have similar overall survival at one and five-year timepoints. Despite relatively more short-term complications, reassuring survival outcomes suggests BTT strategy in LTRs at high volume experienced centers is safe and effective.

Metrics

1 Record Views

Details

Logo image