Early Need of Extracorporeal Membrane Oxygenation After Lung Transplantation: A Retrospective Cohort Study

The current study aimed to assess the national practice patterns of extracorporeal membrane oxygenation (ECMO) use during the early posttransplant period. We included patients in the United Network for Organ Sharing (UNOS) database aged greater than 18 years who underwent lung transplantation (LT) between January 1, 2017 and December 31, 2022 (n = 14,999). The study group was divided based on the need for ECMO at 72 hours after LT, as recorded in the database. We analyzed recipient, donor, and procedure-related variables as potential predictors of need for ECMO. One year survival was the primary outcome variable. The overall incidence of ECMO use after LT was 9% (1,357/14,999), with increasing yearly incidence (6.5%-10.7%). Several recipient variables were independently associated with post-LT ECMO use. Additionally, older donors, donation after circulatory death donors, use of machine perfusion, longer ischemia time, and bilateral LT were additional predictors. Patients with post-LT ECMO use had significantly higher 1 year mortality (30.5% vs. 9%, p < 0.001). It is concluded that post-LT ECMO use was independently associated with worse 1 year mortality. Extracorporeal membrane oxygenation is being increasingly deployed among patients with severe allograft dysfunction. The increase in incidence of post-LT ECMO use appears to be fueled by progressively higher-risk donors and recipients. Patients with post-LT ECMO use continue to experience markedly worse outcomes.