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Background: Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary assistance during lung transplantation (LTx). However, the optimal timing for ECMO removal remains controversial. This study aimed to evaluate the risk factors and early prognosis of delayed withdrawal ECMO after LTx., Methods: Two hundred sixty-seven patients who underwent LTx supported by ECMO were included in this study. Based on whether or not ECMO was completely stopped in the operating room, patients were divided into early ECMO withdrawal group (group E, 107 cases) and delayed withdrawal group (group D, 160 cases). Perioperative data of the donors and recipients, including the suspected risk factors for delayed removal of ECMO, postoperative complications, and hospital survival rate, were retrospectively analyzed., Results: Preoperative New York Heart Association cardiac function for recipients and mechanical ventilation time for donors were independent risk factors for delayed weaning of ECMO in veno-arterial ECMO patients. Compared with group E, the odds of postoperative pulmonary infection, primary graft dysfunction, renal dysfunction, blood transfusion volume, and mechanical ventilation time were significantly higher in group D (all P < 0.05). Delayed withdrawal ECMO was decisive factor for early postoperative death, as the risk of early postoperative death in group D was 1.99 (95% confidence interval, 1.13-3.54) times as that in the group E., Conclusions: During the period of LTx, New York Heart Association grade III/IV for recipients and mechanical ventilation time ≥5 days for donors are suggestive of delayed veno-arterial ECMO removal, and clinicians should minimize the postoperative bypass time of ECMO when conditions permit., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)