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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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000862 |
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| author | Yota Suzuki, MD Rachel L. Deitz, MD, MPH John Ryan, PhD Ernest Chan, MD Masashi Furukawa, MD Chadi Hage, MD Pablo G. Sanchez, MD |
| author_facet | Yota Suzuki, MD Rachel L. Deitz, MD, MPH John Ryan, PhD Ernest Chan, MD Masashi Furukawa, MD Chadi Hage, MD Pablo G. Sanchez, MD |
| author_sort | Yota Suzuki, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-a1324f9ff65640cf9139cae893338d5f |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-a1324f9ff65640cf9139cae893338d5f2025-08-20T03:41:57ZengElsevierJHLT Open2950-13342025-08-01910029110.1016/j.jhlto.2025.100291Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysisYota Suzuki, MD0Rachel L. Deitz, MD, MPH1John Ryan, PhD2Ernest Chan, MD3Masashi Furukawa, MD4Chadi Hage, MD5Pablo G. Sanchez, MD6Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Corresponding author: Yota Suzuki, MD, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.Division of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Lung Transplant and Lung Failure, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PAObjective: 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.http://www.sciencedirect.com/science/article/pii/S2950133425000862ECMOIPFBridge to transplantLung transplantPulmonary hypertension |
| spellingShingle | Yota Suzuki, MD Rachel L. Deitz, MD, MPH John Ryan, PhD Ernest Chan, MD Masashi Furukawa, MD Chadi Hage, MD Pablo G. Sanchez, MD Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis JHLT Open ECMO IPF Bridge to transplant Lung transplant Pulmonary hypertension |
| title | Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis |
| title_full | Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis |
| title_fullStr | Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis |
| title_full_unstemmed | Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis |
| title_short | Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis |
| title_sort | lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis an srtr database analysis |
| topic | ECMO IPF Bridge to transplant Lung transplant Pulmonary hypertension |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000862 |
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