Purpose: Extracorporeal Life Support (ECLS) is increasingly used as a bridge to lung transplantation (LTx) as well as in the management of severe primary graft dysfunction (PGD). However, the data and experience with this therapy remains limited.

Methods: Retrospective study of patients undergoing lung transplantation between 03.2009 and 11.2013 was performed. Outcomes in patients supported on ECLS as a bridge to LTx (Gr1) and for management of PGD (Gr2) were compared with LTx without ECLS (Gr3).

Results: 231 lung transplants were performed in this period (Gr1=13, Gr2=24, and Gr3=194). In Gr1 (median age, 30±11 yrs), the mean time on ECLS was 16 (range: 1-53) days (6 VV ECMO, 5 VA ECMO and 2 NovaLung). Five patients died within 30 days of LTx while 8 survived for more than 1 yr. In Gr2 (mean age, 42±11 yrs), the mean duration of support was 12 (range: 1-50) days (7 VV and 17 VA ECMO). 11 patients died on ECLS support and 13 were successfully weaned (11 were discharged from the hospital and 9 survived for more than 1 year). Gr3 (median age 44±14) consists of patients that did not require ECLS.

1-yr survival was lowest in Gr2 (38%), followed by Gr1 (68%) and Gr3 (93%). There was no statistically significant difference in donor characteristics (age, gender, cause of death, last PO2 before retrieval, percentage of DCD, abnormal chest x-ray and bronchoscopy) or recipient baseline characteristics (age, gender) among the 3 groups. Total ischemic time was longest in Gr1 (p=0.014); duration of mechanical ventilation (p<0.001), ITU (p<0.001) and hospital stay (n. s.) were longest in Gr2 followed by Gr1 and Gr3. Post-LTx PaO2/FiO2 ratios up to 72 hours after surgery (p<0.001) was lowest in GR2.

Conclusion: ECLS is an essential tool in the armamentarium of any lung transplant program providing the potential to bridge patients to transplantation and to overcome graft dysfunction post-LTx with favourable survival rates.

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