Objective: LTx in patients remaining on extracorporeal support is still controversial approach despite good results published by leading transplant centres. In this study we evaluate early end mid-term results in this group.

Methods: Since 12.2010 till 06.2014 188 LTx have been performed in our institution. 14 patients (7.4%) underwent first time LTx being on various kind of extracorporeal support as intension to bridge to LTx. Demographics, preoperative and postoperative variables were retrospectively evaluated.

Results: 17 patients were bridged with intension to transplant: 7 with veno-venous extracorporeal membrane oxygenation (ECMO), 4 with veno-arterial ECMO, 1 with peripheral interventional Lung Assist Device (iLA), 2 with central (pulmonary artery to left atrium) iLA and 3 with combination of listed above for median of 9(6;15) days. 14 patients (82%) survived to LTx. Recipient data: median age – 32(24.5;40.75) years; gender – female/male 12/2; diagnosis – Cystic Fibrosis: 7(50%), Pulmonary Hypertension: 4(28.6%), Pulmonary Fibrosis: 2(14.3%)and Ehlers-Danlos Syndrome: 1(7.1%). 7(50%) of patients remained mechanically ventilated during support, 5(36%) were awake and self-ventilated and 2(14%) awake and self-ventilated more than half of the support. All recipients received double LTx, 11 were operated on cardiopulmonary by-pass and 1 on ECMO support. Median postoperative mechanical ventilation – 318(46.25;416.75) hours, intensive care and hospital stay – 18.5(15.25;27.5) and 39.5(31.75;54.75) days. Actual survival after a median follow up of 462.5(108.25;982) days is 65% and survival to discharge after Ltx 72 %. All patients who remained awake and self-ventilated for at least half of the support duration survived to discharge. 1 patient developed bronchiolitis obliterans syndrome (BOS) during follow up and received successful redo LTx. The others are free from BOS.

Conclusion: Bridging to LTx with extracorporeal devices is a feasible option of treatment in selected patients awaiting transplantation. Avoiding mechanical ventilation during support increases the chance of successful outcome.

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