Early Results After Lung Transplantation In Patients Bridged With Extracorporeal Life Support: Experience From A 7-Year Period

Purpose Extracorporeal life support (ECLS) is being increasingly used in selected patients with end-stage pulmonary disease as a bridge to transplantation (BTT). In this study, we present our experience using preoperative ECLS in lung transplantation (LTx) and evaluate its impact on early outcome and survival. Methods We have performed a single-center retrospective analysis of all adult patients who were consecutively bridged to LTx using ECLS at Harefield Hospital between January 2012 and December 2018. Data were extracted from our institutional electronic medical records. Patients’ preoperative characteristics, use of perioperative ECLS, early postoperative results and in-hospital complications were analysed. Primary endpoint was 30-day mortality. Secondary endpoints were early postoperative outcomes. Results In total, 28 LTx recipients (53.6% males, mean age 32.6±10.6 years) were bridged to bilateral sequential single LTx with ECLS. The most common diagnoses were cystic fibrosis (75%), pulmonary artery hypertension (10.7%), fibrotic lung disease (7.1%), alpha-1 antitrypsin deficiency (3.6%) and others (3.6%). ECLS strategies included venovenous (VV) extracorporeal membrane oxygenation (ECMO; 71.4%), venoarterial (VA) ECMO (17.9%) and Novalung Interventional Lung Assist (iLA) device (10.7%). Median duration of bridging was 6 (range 2-53) days. Sixteen (57.1%) patients were awake and nonintubated during ECLS. Intraoperatively, 13 patients (46.4%) required cardiopulmonary bypass. Eleven patients stayed on VV ECMO, one on VA ECMO and 3 were converted to VA ECMO. Postoperatively, ECLS was utilized in 15 (53.6%) patients (6 VA ECMO/7 VV ECMO/2 Novalung). 30-day mortality was 21.4%. Median intensive care unit stay after LTx was 20 days. We have observed a delayed chest closure in 9 (32.1%) patients, surgical re-exploration for bleeding in 12 (42.9%) and renal failure requiring renal replacement therapy in 18 (64.3%). Conclusion We have performed a descriptive analysis of early postoperative outcomes of LTx in patients bridge with ECLS in a tertiary center over a 7-year period. Overall, we have demonstrated that, even if associated with high rate of early postoperative complications, ECLS as a BTT can be successfully used in selected patients with end-stage respiratory failure in a high-urgency setting.