Abstract
Predictors of ECMO at 72 Hours Post Lung Transplantation in the CAS Era
The Journal of heart and lung transplantation, v 45(5), pp 494-494
Apr 2026
Abstract
Purpose: Severe primary graft dysfunction (PGD), reflected by the need for extracorporeal membrane oxygenation (ECMO) within 72 hours after lung transplantation, is a major cause of early morbidity and mortality. Predictors of ECMO at 72 hours have not been well-characterized since implementation of the Continuous Allocation System (CAS). This study aimed to identify recipient, donor, and perioperative factors associated with ECMO use at 72 hours following lung transplantation in the CAS era.
Methods: The United Network for Organ Sharing (UNOS) database was queried for isolated adult lung transplants (March 2023 to June 2025). The primary outcome was identification of predictors independently associated with ECMO at 72 hours. Variables significant on univariable analysis (p<0.05) were refined by LASSO and entered into separate multivariable logistic models. Adjusted odds ratios (AOR) with 95% CI were reported.
Results: Among 5,942 adult lung transplant recipients, 644 (10.8%) required ECMO within 72 hours. Independent predictors of ECMO use were female sex (AOR 1.52, 95% CI 1.38-1.68, p<0.001), history of cigarette use (AOR 0.79, 95% CI 0.72-0.88, p<0.001), prior cardiac surgery (non-transplant) (AOR 1.15, 95% CI 1.03-1.27, p=0.01), ECMO at transplant (AOR 3.68, 95% CI 3.11-4.36, p<0.001), ICU status at transplant (AOR 1.83, 95% CI 1.56-2.16, p<0.001), hospitalization (non-ICU) (AOR 1.35, 95% CI 1.16-1.58, p<0.001), donor cause of death: cerebrovascular/stroke (AOR 0.79, 95% CI 0.71-0.89, p<0.001) and head trauma (AOR 0.85, 95% CI 0.76-0.95, p<0.01), and ischemic time (AOR 1.16, 95% CI 1.15-1.17, p<0.001), among others (Table 1).
Conclusion: Several clinical and physiologic factors, including female sex, higher BMI, and pulmonary hypertension, were independently associated with the development of severe PGD after lung transplantation in the CAS era. Recognizing these predictors preoperatively may help guide risk stratification and optimize perioperative management to improve outcomes.
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Details
- Title
- Predictors of ECMO at 72 Hours Post Lung Transplantation in the CAS Era
- Creators
- S. McKay - University of California, Los AngelesJ. Song - University of California, Los AngelesJ.P. Joshi - University of California, Los AngelesN.A. Tan - University of California, Los AngelesH. Zappacosta - University of California, Los AngelesP. Cho - Drexel University, College of MedicineJ. White - University of California, Los AngelesA. Abramov - University of California, Los AngelesM. Husain - University of California, Los AngelesD. Telesca - University of California, Los AngelesM. Daniel - University of California, Los AngelesA. Ardehali - University of California, Los Angeles
- Publication Details
- The Journal of heart and lung transplantation, v 45(5), pp 494-494
- Conference
- 46th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT) (Toronto, Ontario, Canada, 22 Apr 2026–26 Apr 2026)
- Publisher
- Elsevier Inc
- Number of pages
- 1
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001762496900116
- Other Identifier
- 991022189369004721