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

*Yoshiya Toyoda Invited Discussant
Temple University Hospital
Philadelphia, PA 
United States  - Contact Me

Chief, Division of Cardiovascular Surgery, Department of Surgery, Temple University Hospital, Philadelphia, PA, USA; Professor of Surgery, William Maul Measey Chair in Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

Specialty interests: Coronary artery bypass surgery including off pump coronary artery bypass and minimally invasive coronary artery bypass, valve repair and replacement, minimally invasive heart valve surgery, Ross procedure, thoracic and thoracoabdominal aortic diseases, endocarditis, cardiac reoperations, adult congenital cardiac surgery, pulmonary thromboendarterectomy, ECMO, LVAD, heart, lung and heart-lung transplantation.

Education and Training: MD and PhD from Kobe University, Kobe, Japan. Advanced cardiac surgery training at the Massachusetts General Hospital, Boston, MA and thoracic transplant and mechanical circulatory support training at the University of Pittsburgh Medical Center, Pittsburgh, PA. Division Chief of Cardiothoracic Transplantation at University of Pittsburgh Medical Center from 2008 to 2011 and Division Chief of Cardiovascular Surgery at the Temple University Hospital from 2015 to present.

Publications and Speaking: More than 250 peer-reviewed manuscripts and book chapters related to his research in cardiothoracic surgery, and more than 500 presentations at conferences and meetings, including the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Numerous lectures nationally and internationally.

Mallory Hunt Abstract Presenter
Hospital of the University of Pennsylvania (Penn Medicine)
United States  - Contact Me

Dr. Mallory Hunt is a clinical PGY5 integrated cardiothoracic surgery resident at the Hospital of the University of Pennsylvania (Penn Medicine).

Saturday, May 6, 2023: 10:15 AM - 10:30 AM
15 Minutes 
Los Angeles Convention Center 
Room: 408A 

Abstract

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.

Presentation Duration

7 minute presentation; 7 minute discussion 

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