Perioperative cardiovascular and cerebrovascular outcomes in recipients of ECMO bridge to lung transplant

Abstract

Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has increased over time. While 1-year and overall survival have been reported to be similar with non-ECMO transplant recipients, there are limited data on major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB) events. In this study, we sought to evaluate the incidence of perioperative MACCE and CRB in lung transplant recipients who underwent ECMO BTT. Methods: Using the National Inpatient Sample from 2008-2019, we identified 5,254 lung transplant recipients who either received or did not require pretransplant ECMO. Perioperative MACCE and CRB were compared between the 2 cohorts. Results: Patients with ECMO BTT had a higher incidence of MACCE compared to non-ECMO patients (35% vs 13.3%, p < 0.0001) and CRB (34.5% vs 12.9%, p < 0.0001). Recipients of pretransplant ECMO for double lung transplant (n = 158) were more likely to have perioperative MACCE and CRB as opposed to patients without pretransplant ECMO (n = 3,584) (adjusted odds ratio 2.69, p < 0.0001; 95% confidence interval 1.86-3.80). The ECMO BTT cohort was notably younger with less cardiac comorbidities and higher diagnoses of cystic fibrosis and interstitial lung disease. Conclusions: Our data indicate that lung transplant recipients who required ECMO BTT are at significantly higher risk of MACCE and bleeding events despite being younger with less comorbidities as opposed to those who did not require ECMO.

Keywords

• ECMO
• bridge to transplantation
• lung transplantation
• MACCE
• bleeding