Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:40

Article

Furfaro, David¹  Rosenzweig, Erika B.²  Shah, Lori¹  Robbins, Hilary¹  Anderson, Michaela¹  Kim, Hanyoung¹  Abrams, Darryl¹  Agerstrand, Cara L.¹  Brodie, Daniel¹  Feldhaus, Danielle³  Costa, Joseph³  Lemaitre, Philippe³  Stanifer, Bryan P.³  D'Ovidio, Frank³  Sonett, Joshua R.³  Arcasoy, Selim¹  Benvenuto, Luke¹ 

[1] Columbia Univ, Dept Med, Div Pulm & Crit Care Med, Irving Med Ctr, New York, NY USA

[2] Columbia Univ, Dept Pediat, Irving Med Ctr, New York, NY 10027 USA

[3] Columbia Univ, Dept Surg, Div Cardiothorac Surg, Sect Gen Thorac Surg,Irving Med Ctr, New York, NY USA

关键词: lung transplant;    ECMO;    pulmonary hypertension;    advanced lung disease;    lung allocation score;   

DOI  :  10.1016/j.healun.2021.08.005

来源: Elsevier

【 摘 要 】

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as a bridge to lung transplantation, but ECMO status is not explicitly accounted for in the Lung Allocation Score (LAS). We hypothesized that among waitlist patients on ECMO, patients with pulmonary arterial hypertension (PAH) would have lower transplantation rates. METHODS: Using United Network for Organ Sharing data, we conducted a retrospective cohort study of patients who were >= 12 years old, active on the lung transplant waitlist, and required ECMO support from June 1, 2015 through June 12, 2020. Multivariable competing risk analysis was used to examine waitlist outcomes. RESULTS: 1064 waitlist subjects required ECMO support; 40 (3.8%) had obstructive lung disease (OLD), 97 (9.1%) had PAH,138 (13.0%) had cystic fibrosis (CF), and 789 (74.1%) had interstitial lung disease (ILD). Ultimately, 671 (63.1%) underwent transplant, while 334 (31.4%) died or were delisted. The transplant rate per person-years on the waitlist on ECMO was 15.41 for OLD, 6.05 for PAH, 15.66 for CF, and 15.62 for ILD. Compared to PAH patients, OLD, CF, and ILD patients were 78%, 69%, and 62% more likely to undergo transplant throughout the study period, respectively (adjusted SHRs 1.78 p = 0.007, 1.69 p = 0.002, and 1.62p = 0.001). The median LAS at waitlist removal for transplantation, death, or delisting were 75.1 for OLD, 79.6 for PAH, 91.0 for CF, and 88.3 for ILD (p < 0.001). CONCLUSIONS: Among patients bridging to transplant on ECMO, patients with PAH had a lower transplantation rate than patients with OLD, CF, and ILD. (C) 2021 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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