Background: Extracorporeal membrane oxygenation (ECMO) is widely accepted as a means of support before lung transplantation (LTx), but limited data exist regarding its impact on long-term survival in association with patient age and covariates that may be influencing clinical outcomes.
Methods: The United Network for Organ Sharing (UNOS) database was queried from 2000 to 2013 for adult recipients (≥18 years) to assess the impact of age on survival in patients on ECMO before LTx.
Results: From a total 17,556 adult lung recipients, 17,441 were included for univariate and Kaplan-Meier function analysis, 15,553 for multivariate Cox models and 364 for propensity score matching. Univariate (HR = 1.804, 95% CI 1.441-2.258, p < 0.001) and multivariate (HR = 1.845, 95% CI 1.450-2.347, p < 0.001) Cox models identified a survival difference between ECMO and no ECMO, which was confirmed by propensity score matching (HR = 2.500, 95% CI 1.525-4.099, p < 0.001). Sub-group analysis demonstrated that younger age (<40 years) was not associated with a significantly increased risk of death, whereas older age (≥60 years) was by univariate (HR = 2.373, 95% CI 11.600-3.518, p < 0.001) and multivariate (HR = 2.364, 95% CI 1.566-3.568, p < 0.001) Cox models when comparing ECMO vs no ECMO. This effect associated with older age was confirmed by propensity score matching (HR = 3.000, 95% CI 1.191-7.558, p = 0.020).
Conclusions: Although ECMO adversely impacted survival in a contemporary cohort of adult lung transplant recipients, the negative effect centered on older patients.
Keywords: adult; age; extracorporeal membrane oxygenation; lung transplantation; organ procurement; survival.
Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.