Outcomes of Lung Transplant with Extracorporeal Membrane Oxygenation in Elderly Patients
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0207
Submission Type:
Abstract Submission
Authors:
Roh Yanagida (1), Masashi Azuma (2), Abul Kashem (2), Hiromu Kehara (2), Kewal Krishan (2), Ravishankar Raman (2), Francis Cordova (2), Yoshiya Toyoda (2)
Institutions:
(1) Lewis Katz School of Medicine at Temple University, Phildelphia, PA, (2) Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Submitting Author:
Roh Yanagida
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Co-Author(s):
Masashi Azuma
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Abul Kashem
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Hiromu Kehara
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Kewal Krishan
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Ravishankar Raman
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Francis Cordova
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
*Yoshiya Toyoda
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Lewis Katz School of Medicine at Temple University
Lewis Katz School of Medicine at Temple University
Presenting Author:
Roh Yanagida
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Temple University Hospital
Temple University Hospital
Abstract:
Objective
Bridging sick patients to lung transplant (LTx) with ECMO has been more commonly performed in the past decade. As transplant candidates age this strategy is more commonly considered for elderly patients. The outcomes of elderly patients in this sickest cohort for LTx are not clear.
Methods
Retrospective analysis of patients undergoing LTx with ECMO as a bridge using United Network of Organ Sharing registry data from 2013 to 2023 was performed. The cohort was stratified based on patients' age: 60 or older and younger than 60. Post-transplant survival and risk factors were investigated in this elderly cohort using Chi-square and ANOVA tests for nominal and continuous variables, respectively. Survival was assessed with Kaplan-Meier analysis, Cox proportional hazard models, and log-rank tests. Multivariate analysis was performed to identify risk factors.
Results
Of 23,513 patients who received LTx during the study period 1546 patients (6.6%) underwent with ECMO as a bridge. Of those 360 patients (23.3%) were older than 60 (mean age 64.3 ± 3.4 years). Interstitial lung disease was the most common etiology (66.9%). Elderly group was less pulmonary hypertensive, (29.9 ± 12.6 mmHg vs 34.3 ± 15.8 mmHg, p<0.001) and underwent single lung transplant more commonly (15.0% vs 3.2%, p<0.001). Elderly cohort was less likely to be mechanically ventilated pre-ECMO (71.6% vs 76.9 %, p = 0.043). There were no significant differences in post-operative ECMO (p=0.837) and renal replacement therapy (p=0.939). Survival of the elderly group was significantly lower at 1, 3 and 5 years (83% vs 76%, 67% vs 57% and 56% vs 45%, p<0.001) than that of younger patients. Survival of the elderly recipients who received single LTx was significantly lower at 1, 3 and 5 years (78% vs 63%, 61% vs 35% and 47% vs 23%, p<0.003) than that of double recipients. Less BOS/CLAD (3.0% vs 15.5%, p<0.003) and more infection (17.9% vs 27.2%, p<0.003) were the cause of death in the elderly group. In multivariate analysis risk factors for outcome were BMI (p<0.001), single LTx (p<0.001), ischemic time (p<0.001) and length of stay (p<0.001), however, age was no longer significant (p=0.331).
Conclusions
The sickest elderly patients with advanced lung disease whose survival is extremely limited without LTx gain reasonable survival benefits with ECMO as a bridge. Age may not be the most crucial factor when elderly patients are considered for ECMO bridge to LTx.
Bridging sick patients to lung transplant (LTx) with ECMO has been more commonly performed in the past decade. As transplant candidates age this strategy is more commonly considered for elderly patients. The outcomes of elderly patients in this sickest cohort for LTx are not clear.
Methods
Retrospective analysis of patients undergoing LTx with ECMO as a bridge using United Network of Organ Sharing registry data from 2013 to 2023 was performed. The cohort was stratified based on patients' age: 60 or older and younger than 60. Post-transplant survival and risk factors were investigated in this elderly cohort using Chi-square and ANOVA tests for nominal and continuous variables, respectively. Survival was assessed with Kaplan-Meier analysis, Cox proportional hazard models, and log-rank tests. Multivariate analysis was performed to identify risk factors.
Results
Of 23,513 patients who received LTx during the study period 1546 patients (6.6%) underwent with ECMO as a bridge. Of those 360 patients (23.3%) were older than 60 (mean age 64.3 ± 3.4 years). Interstitial lung disease was the most common etiology (66.9%). Elderly group was less pulmonary hypertensive, (29.9 ± 12.6 mmHg vs 34.3 ± 15.8 mmHg, p<0.001) and underwent single lung transplant more commonly (15.0% vs 3.2%, p<0.001). Elderly cohort was less likely to be mechanically ventilated pre-ECMO (71.6% vs 76.9 %, p = 0.043). There were no significant differences in post-operative ECMO (p=0.837) and renal replacement therapy (p=0.939). Survival of the elderly group was significantly lower at 1, 3 and 5 years (83% vs 76%, 67% vs 57% and 56% vs 45%, p<0.001) than that of younger patients. Survival of the elderly recipients who received single LTx was significantly lower at 1, 3 and 5 years (78% vs 63%, 61% vs 35% and 47% vs 23%, p<0.003) than that of double recipients. Less BOS/CLAD (3.0% vs 15.5%, p<0.003) and more infection (17.9% vs 27.2%, p<0.003) were the cause of death in the elderly group. In multivariate analysis risk factors for outcome were BMI (p<0.001), single LTx (p<0.001), ischemic time (p<0.001) and length of stay (p<0.001), however, age was no longer significant (p=0.331).
Conclusions
The sickest elderly patients with advanced lung disease whose survival is extremely limited without LTx gain reasonable survival benefits with ECMO as a bridge. Age may not be the most crucial factor when elderly patients are considered for ECMO bridge to LTx.
THORACIC:
End Stage Lung Disease and Lung Transplantation
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