Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation

J Heart Lung Transplant. 2015 Jun;34(6):832-8. doi: 10.1016/j.healun.2014.12.014. Epub 2014 Dec 23.

Abstract

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aging / physiology*
  • Extracorporeal Membrane Oxygenation / adverse effects*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Respiratory Insufficiency / mortality*
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Survival Rate
  • Time Factors