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 1.62 p = 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.

中文翻译：

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体外膜肺氧合桥接移植患者基于诊断的肺移植差异

背景

体外膜肺氧合 (ECMO) 越来越多地用作肺移植的桥梁，但肺分配评分 (LAS) 中并未明确说明 ECMO 状态。我们假设在等待 ECMO 的患者中，肺动脉高压 (PAH) 患者的移植率较低。

方法

使用器官共享联合网络数据，我们对 2015 年 6 月 1 日至 2020 年 6 月 12 日 12 岁以上、在肺移植候补名单上活跃并需要 ECMO 支持的患者进行了一项回顾性队列研究。多变量竞争风险分析是用于检查候补名单结果。

结果

1064 名候补科目需要 ECMO 支持；40 人（3.8%）患有阻塞性肺病（OLD），97 人（9.1%）患有 PAH，138 人（13.0%）患有囊性纤维化（CF），789 人（74.1%）患有间质性肺病（ILD）。最终，671 人（63.1%）接受了移植，334 人（31.4%）死亡或被除名。ECMO 候补名单上的每人年移植率为 OLD 15.41，PAH 6.05，CF 15.66，ILD 15.62。

与 PAH 患者相比，OLD、CF 和 ILD 患者在整个研究期间接受移植的可能性分别高出 78%、69% 和 62%（调整后的 SHR 1.78 p  = 0.007、1.69 p  = 0.002 和 1.62 p  = 0.001)。因移植、死亡或除名而被移除的等待名单中的 LAS 中位数为 OLD 75.1、PAH 79.6、CF 91.0 和 ILD 88.3（p < 0.001）。

结论

在 ECMO 桥接移植的患者中，PAH 患者的移植率低于 OLD、CF 和 ILD 患者。