Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis
Objective: Extracorporeal Membrane Oxygenation (ECMO) plays an important role in bridge-to-transplant, but the ideal bridging strategy is not well-defined for idiopathic pulmonary fibrosis (IPF), particularly in the setting of pulmonary hypertension (PH). Methods: We queried data from the Scientific...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-08-01
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| Series: | JHLT Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000862 |
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| Summary: | Objective: Extracorporeal Membrane Oxygenation (ECMO) plays an important role in bridge-to-transplant, but the ideal bridging strategy is not well-defined for idiopathic pulmonary fibrosis (IPF), particularly in the setting of pulmonary hypertension (PH). Methods: We queried data from the Scientific Registry of Transplant Recipients database for adult lung transplant candidates with IPF who were bridged to lung transplant, either with venovenous (VV)-ECMO, venoarterial (VA)-ECMO, or mechanical ventilator (MV) alone. A subgroup analysis was performed on patients with moderate-severe PH (mean pulmonary artery pressure ≥ 40 mmHg). Results: During the period, 1485 patients were identified who met inclusion criteria: 653 on VV-ECMO, 234 on VA-ECMO, and 598 on MV. The competing risk analysis found that relative to VV-ECMO, both VA-ECMO and MV bridge were associated with lower rates of survival to transplant (HR 0.69 [0.57-0.84], p < 0.001; HR 0.39 [0.383-0.46], p < 0.001, respectively). Within the PH subgroup, there was no difference in survival to transplant between VV- and VA-ECMO (HR 1.01 [0.64-1.58]; p > 0.9), but patients bridged with ventilator had a lower waitlist survival rate HR 0.46 [0.27, 0.79]; p = 0.005) relative to VV-ECMO. There was no difference in long-term survival among the three bridging strategies, either in the complete cohort (p = 0.52) or the PH cohort (p = 0.84). Conclusions: Even in the presence of severe PH, VA- and VV-ECMO were both effective in bridging IPF patients to lung transplant, and VV-ECMO can be an initial setup for bridging. Conversion to VA ECMO may be considered early when there is a sign of right ventricular dysfunction. |
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| ISSN: | 2950-1334 |