Lung Transplantation Outcomes for Patients with Acute Respiratory Distress Syndrome (ARDS) Requiring Preoperative ECMO: A Comparison of COVID ARDS and Non-COVID ARDS

64 

Abstract Submission 

Mallory Hunt (1), Maria Crespo (2), Thomas Richards (2), Francisca Bermudez (3), Andrew Courtwright (2), Asad Usman (4), Audrey Spelde (2), Joshua Diamond (2), Namrata Patel (2), Edward Cantu (5), Jason Christie (2), Emily Clausen (2), Marisa Cevasco (2), Christian Bermudez (2)

(1) Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA, (2) Hospital of the University of Pennsylvania, Philadelphia, PA, (3) N/A, N/A, (4) N/A, philadelphia, PA, (5) Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Mallory Hunt    -  Contact Me
Hospital of the University of Pennsylvania

Maria Crespo    -  Contact Me
Hospital of the University of Pennsylvania

Thomas Richards    -  Contact Me
Hospital of the University of Pennsylvania

Francisca Bermudez    -  Contact Me
N/A

Andrew Courtwright    -  Contact Me
Hospital of the University of Pennsylvania

Asad Usman    -  Contact Me
N/A

Audrey Spelde    -  Contact Me
Hospital of the University of Pennsylvania

Joshua Diamond    -  Contact Me
Hospital of the University of Pennsylvania

Namrata Patel    -  Contact Me
Hospital of the University of Pennsylvania

♦Edward Cantu    -  Contact Me
Perelman School of Medicine, University of Pennsylvania

Jason Christie    -  Contact Me
Hospital of the University of Pennsylvania

Emily Clausen    -  Contact Me
Hospital of the University of Pennsylvania

Marisa Cevasco    -  Contact Me
Hospital of the University of Pennsylvania

♦Christian Bermudez    -  Contact Me
Hospital of the University of Pennsylvania

Mallory Hunt    -  Contact Me
N/A

Objective: Lung transplantation (LTx) has rarely been performed in patients with ARDS supported on ECMO. An important change in this practice was observed as a result of the COVID-19 pandemic. This study aims to compare the outcomes of patients who underwent LTx for ARDS due to COVID and non-COVID etiologies, and to assess the impact of type and duration of ECMO support on survival. Methods: Using the UNOS database, we performed a retrospective study of patients who underwent LTx for ARDS in the United States between February 2007 and June 2022. A total of 311 patients with ARDS were identified using primary diagnosis at the time of listing; 244/311 were diagnosed with COVID-19 ARDS (CARDS) and 67/311 with non-COVID ARDS (N-CARDS). Of these patients, we analyzed 236 who underwent LTx after preoperative ECMO support. The primary outcome was one-year survival. Secondary outcomes included the effect of type and duration of ECMO support on survival. Survival analyses were conducted using the Kaplan-Meier survival function and Cox proportional hazards models. Results: A total of 236 patients underwent LTx for ARDS with preoperative ECMO support. Of these, 181 (77%) had a listing diagnosis of CARDS and 55 (23%) of N-CARDS. ECMO device information was available for 168 patients. Patients with CARDS were older (46 vs 32 years, p <0.001), more likely to be female (46% vs 27%, p=0.0014), and had higher BMI (27.3 vs 25.3, p=0.019) than the N-CARDS cohort. Overall, patients with CARDS had longer waitlist times (11 vs 6 days, p=0.0068) and were less likely to require pre-transplant dialysis (7.2% vs 9.1%, p <0.0001) than N-CARDS patients. The two groups had similar 1-year survival rates (85.8% vs 81.1% for CARDS and N-CARDS patients, respectively, p=0.2) (Figure 1). There were no differences in postoperative complications including renal failure, stroke, or acute rejection (all p >0.28). N-CARDS patients were significantly more likely to require pre-LTx support with VA ECMO (21.4% vs 7.1%; p=0.03) and CARDS patients required longer times on ECMO pre-transplant (72.5 vs 56 days, p=0.017). Despite this, duration of ECMO support was not a univariate predictor of one-year post-transplant survival (p=0.2). Conclusions: Our data suggests that, despite prolonged periods of pre-transplant ECMO support, selected CARDS and N-CARDS patients can be transplanted safely with acceptable short-term outcomes. Appropriate selection and long-term implications require further analysis.

End Stage Lung Disease and Lung Transplantation