533 - ECMO following Lung Transplantation: Early Use Associated with Better Survival

Publication Number: 1512.533

Meera Sago, Boston Children's Hospital, Boston, MA, United States; Alireza Akhondi-Asl, Boston Children's Hospital, Boston, MA, United States; Daniel Gagner, Boston Children's Hospital, Boston, MA, United States; Peta M.A.. Alexander, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Dennis Daniel, Boston Children's Hospital, Boston, MA, United States; Ravi R. Thiagarajan, Boston Children's Hospital, Chestnut Hill, MA, United States

Background: Extracorporeal Membrane Oxygenation (ECMO) is an invasive mechanical circulatory support strategy that can be used in post-thoracic organ transplantation recipients for cardiorespiratory failure associated with primary graft dysfunction, providing critical time for the transplanted graft to recover. Though ECMO has been increasingly used post-lung transplantation, its efficacy and outcomes for pediatric lung transplant recipients remain poorly understood.

Objective: We describe trends in use and factors associated with survival in children and young adults supported with ECMO after lung transplantation.

Design/Methods: Using the Extracorporeal Life Support Organization registry database, we conducted a retrospective cohort study of pediatric and young adult patients (age 0-20 years) placed on ECMO after lung transplantation during 2010-2023. The primary outcome was survival to hospital discharge. Multivariate logistic regression and multinomial regression models were used to describe factors associated with survival.

Results: Ninety children and young adults were supported with ECMO post-lung transplantation. Median age was 16 years [IQR: 8.9-18.0] and 48 (53.3%) patients were female. Twenty-one (23.3%) patients had a primary diagnosis of cystic fibrosis, 14 (15.5%) with primary pulmonary hypertension, and 5 (5.5%) with acute respiratory failure; 43 (47.8%) patients underwent venoarterial (VA) and 35 (38.9%) venovenous (VV) ECMO. Fifty-four (60%) patients survived after ECMO post-lung transplantation. Forty-nine (91%) survivors were cannulated to ECMO within 72 hours of lung transplantation (early graft failure) compared to 5 (9%) cannulated >/=72 hours. Overall survival improved over time between 2010-2023 (p=0.031).

Conclusion(s): Survival to hospital discharge has improved in children and young adults. Those placed on ECMO within the first 72 hours after lung transplantation (early graft failure) had higher survival to hospital discharge. Survival was not significantly impacted by primary diagnosis, mode (VA or VV), or duration of ECMO.