A single institution analysis of 572 lung transplants: impact of pre-operative ECMO
Presented During:
Friday, September 20, 2024: 5:00PM - 6:30PM
Omni King Edward Hotel
Abstract No:
10155
Submission Type:
Abstract Submission
Authors:
YURIY STUKOV (1), Ahmet Bilgili (2), Lindsey Brinkley (1), Liam Kugler (3), Amir Emtiazjoo (4), Marc Maybauer (5), Mindaugas Rackauskas (6)
Institutions:
(1) The University of Florida, Gainesville, FL, (2) N/A, N/A, (3) Student, Gainesville, FL, (4) University of Florida, Gainesville, FL, (5) Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, (6) N/A, Gainesville, FL
Submitting Author:
YURIY STUKOV
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The University of Florida
The University of Florida
Co-Author(s):
Ahmet Bilgili
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N/A
N/A
Lindsey Brinkley
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The University of Florida
The University of Florida
Liam Kugler
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Student
Student
Amir Emtiazjoo
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University of Florida
University of Florida
Marc Maybauer
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Division of Critical Care Medicine, Department of Anesthesiology, University of Florida
Division of Critical Care Medicine, Department of Anesthesiology, University of Florida
Mindaugas Rackauskas
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N/A
N/A
Presenting Author:
YURIY STUKOV
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The University of Florida
The University of Florida
Abstract:
Objective. The list of patients with end-stage lung disease who are waiting for the lung transplantation continues to grow. Despite maximum medical therapy and supplemental oxygen, some patients require ECMO as a bridge to lung transplantation. The purpose of this study is to present our clinical experience in patients who were supported with ECMO pre-operatively by describing pre-, peri-, and post-operative outcomes as well as assessing longitudinal survival.
Methods: We reviewed outcomes of all lung transplants between 2013-2023 at our institution. Patients were assigned to the following two groups: Group 1: patients supported with ECMO prior to transplantation and Group 2: patients with no mechanical circulatory support prior to transplantation. The primary outcome was mortality. Univariate comparisons of categorical and continuous variables were analyzed using a Chi-square test and Wilcoxon rank sum test after assessing normality. Kaplan-Meier (KM) methods and log-rank tests were used to assess group differences in long-term survival. T-tests using KM-estimated survival proportions and standard errors were used to compare post-transplant survival of groups at one, three, and five years. Continuous variables are represented as median [IQR] and categorical variables are represented as N(%).
Results: The entire cohort consisted of a total of 572 patients (n=65, supported with pretransplant ECMO; n=507 no pretransplant mechanical circulatory support). Patients supported with ECMO prior to lung transplantation were more likely to be older (62.5 years [53.9-67.9] vs 49.0 years [35-54.2], p = <0.001), have right ventricular dysfunction (n=43, 66.2% vs n=103, 20.3%; p <0.001) and have a history of renal failure (n=6, 9.2% vs n=11, 2.2%; p=0.006). Additionally, patients supported with ECMO pre transplant were more likely to have all-cause post-transplant complications (n=64, 98.5% vs n=394, 77.7%; p<0.001), including post-operative infection (n=43, 66.2% vs n=243, 47.9%; p=0.009) and bleeding (n=26, 40.0% vs n=53, 10.5%; p < 0.001). Patients supported with pretransplant ECMO additionally were more likely to have longer hospital length of stays (80 days [60.8-109.0] vs 28.0 days [17.5-57.5], p = <0.001), and be supported with post-transplant ECMO (n=57, 87.7% vs n=98, 19.3%; p<0.001). We observed no statistically significant difference in post operative stroke (n=2, 3.1% vs n=7 ,1.4%; p=0.62) and unplanned readmission within 30 days between groups (n=0, 0.0% vs n= 33, 6.5%; p=0.06). Upon survival analysis, longitudinal survival did not differ between groups at 1 (93.4% [95% CI:91.2-95.6%] vs 90.7% [95% CI:83.9-98.1%], log-rank = 0.655), 3 (79.9% [95% CI:76.2-83.8%] vs 77.4% [95% CI:65.6-91.2%], log-rank = 0.386), and 5 years post-transplant (61.9% [95% CI:56.3-68.1%] vs 42.0% [95% CI:20.8-84.8%], log-rank = 0.31.)(Figure 1).
Conclusions: Excellent post-transplant survival can be expected in patients with end-stage lung disease. Patients supported with ECMO as a bridge to lung transplantation tended to be sicker and had more immediate post-operative complications however, longitudinal survival did not differ between ECMO supported patients and those without mechanical circulatory support before transplant. Advances in the treatment of chronic lung allograft dysfunction will lead to improvements in long-term survival.
Methods: We reviewed outcomes of all lung transplants between 2013-2023 at our institution. Patients were assigned to the following two groups: Group 1: patients supported with ECMO prior to transplantation and Group 2: patients with no mechanical circulatory support prior to transplantation. The primary outcome was mortality. Univariate comparisons of categorical and continuous variables were analyzed using a Chi-square test and Wilcoxon rank sum test after assessing normality. Kaplan-Meier (KM) methods and log-rank tests were used to assess group differences in long-term survival. T-tests using KM-estimated survival proportions and standard errors were used to compare post-transplant survival of groups at one, three, and five years. Continuous variables are represented as median [IQR] and categorical variables are represented as N(%).
Results: The entire cohort consisted of a total of 572 patients (n=65, supported with pretransplant ECMO; n=507 no pretransplant mechanical circulatory support). Patients supported with ECMO prior to lung transplantation were more likely to be older (62.5 years [53.9-67.9] vs 49.0 years [35-54.2], p = <0.001), have right ventricular dysfunction (n=43, 66.2% vs n=103, 20.3%; p <0.001) and have a history of renal failure (n=6, 9.2% vs n=11, 2.2%; p=0.006). Additionally, patients supported with ECMO pre transplant were more likely to have all-cause post-transplant complications (n=64, 98.5% vs n=394, 77.7%; p<0.001), including post-operative infection (n=43, 66.2% vs n=243, 47.9%; p=0.009) and bleeding (n=26, 40.0% vs n=53, 10.5%; p < 0.001). Patients supported with pretransplant ECMO additionally were more likely to have longer hospital length of stays (80 days [60.8-109.0] vs 28.0 days [17.5-57.5], p = <0.001), and be supported with post-transplant ECMO (n=57, 87.7% vs n=98, 19.3%; p<0.001). We observed no statistically significant difference in post operative stroke (n=2, 3.1% vs n=7 ,1.4%; p=0.62) and unplanned readmission within 30 days between groups (n=0, 0.0% vs n= 33, 6.5%; p=0.06). Upon survival analysis, longitudinal survival did not differ between groups at 1 (93.4% [95% CI:91.2-95.6%] vs 90.7% [95% CI:83.9-98.1%], log-rank = 0.655), 3 (79.9% [95% CI:76.2-83.8%] vs 77.4% [95% CI:65.6-91.2%], log-rank = 0.386), and 5 years post-transplant (61.9% [95% CI:56.3-68.1%] vs 42.0% [95% CI:20.8-84.8%], log-rank = 0.31.)(Figure 1).
Conclusions: Excellent post-transplant survival can be expected in patients with end-stage lung disease. Patients supported with ECMO as a bridge to lung transplantation tended to be sicker and had more immediate post-operative complications however, longitudinal survival did not differ between ECMO supported patients and those without mechanical circulatory support before transplant. Advances in the treatment of chronic lung allograft dysfunction will lead to improvements in long-term survival.
Mechanical Support and Thoracic Transplantation Summit:
Lung Transplant
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