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Outcomes in Lung Transplant Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) in the Perioperative Period.

A. Habertheuer, M. Williams, S. Miller, E. Cantu, C. Bermudez, P. Vallabhajosyula.

Cardiovascular Surger, Hospital of the University of Pennsylvania, Philadelphia, PA.

Meeting: 2016 American Transplant Congress

Abstract number: B288

Keywords: Lung transplantation, Mechnical assistance, Outcome, Risk factors

Session Information

Date: Sunday, June 12, 2016

Session Name: Poster Session B: Lung Transplantation Posters

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

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  • Characteristics and Outcome of Patients Placed on Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation.
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Objective As ECMO therapy is increasingly used to bridge high-risk patients with end-stage respiratory failure to lung transplantation, outcomes of this strategy employed in the perioperative period are not well studied. We report outcomes of this high-risk cohort.

Methods From 2004 to 2014, the Pennsylvania Health Cost Containment Council (PHC4) database was retrospectively reviewed for single (SLT)/bilateral lung transplantations (BLT) and ECMO. 237 patients were identified (mean age 53.9±12.9, 42.6% female), 80.2% (n=190) required ECMO support post-transplant (Group 1), and 19.8% (n=47) were ECMO dependent pre-transplant (Group 2), of which 7 patients stayed on ECMO post-transplant. Groups were compared using descriptive statistics; a logistic regression model was constructed to identify risk factors for in-hospital and midterm mortality over a follow-up of 2 years.

Results Group 2 patients were younger (46.9±13.1 vs 55.7±12.3,p<0.01) with a higher frequency of cystic fibrosis (42.4% vs 7.3%, p<0.01). 100% of Group 2 patients underwent BLT compared to 84.2% in Group 1 (p=0.004). Median duration of pre-transplant ECMO was 6d (interquartile range 3-12d) with a higher proportion requiring prolonged ventilation (>96h) (51.1% vs 29.5%, p=0.005). Both in-hospital and midterm all-cause mortality was lower in Group 2 (10.6% vs 32.1%, p=0.003 and 19.1% vs 42.1%, p=0.004; . Of 7 patients remaining on ECMO post-transplant, 14.3% died in-hospital. COPD was the prevalent etiology in group I patients (16.3% vs 2.1, p=0.011), mean hospital length of stay was 49.3±35.2d vs 61.9±26.2d, p=0.034. On logistic regression, age and post-transplant renal failure were independent risk factors for in-hospital (Odds Ratio OR=1.04 and OR=5.37) and midterm mortality (OR=1.03 and OR=2.24).

Conclusion Use of ECMO to bridge carefully selected patients to lung transplantation offers acceptable perioperative and midterm outcomes. Requirement for ECMO in the post-transplant period is associated with higher mortality. Age and renal failure are risk factors in this high-risk cohort.

CITATION INFORMATION: Habertheuer A, Williams M, Miller S, Cantu E, Bermudez C, Vallabhajosyula P. Outcomes in Lung Transplant Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) in the Perioperative Period. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Habertheuer A, Williams M, Miller S, Cantu E, Bermudez C, Vallabhajosyula P. Outcomes in Lung Transplant Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) in the Perioperative Period. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-lung-transplant-patients-requiring-extracorporeal-membrane-oxygenation-ecmo-in-the-perioperative-period/. Accessed February 25, 2021.

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