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Despite the increasing number of heart-kidney transplants being performed in recent years, renal failure after heart transplantation remains a pervasive recipient complication. The purpose of this study was to determine the predictors and outcomes of renal failure after heart transplantation in a contemporary cohort. This was a retrospective cohort study of all adults undergoing isolated heart transplantation in the 2018-2022 United Network for Organ Sharing database. Heart recipients were stratified into those experiencing postoperative renal failure requiring dialysis prior to discharge and those without renal failure. We used multivariable logistic regression to determine factors associated with postoperative renal failure and compared postoperative outcomes between groups. Of 10,545 patients undergoing heart transplantation, 1,485 (14%) experienced postoperative renal failure. Factors associated with increased odds of renal failure included: increasing creatinine (odds ratio, OR 2.09/mg/dL 95% CI 1.85-2.35), pretransplant dialysis (OR 4.83, 95% CI 3.46-6.74), ventilation (OR 1.86, 95% CI 1.28-2.69) or extracorporeal membrane oxygenation (OR 1.78, 95% CI 1.38-2.29) prior to transplant, and prior cardiac surgery (OR 1.41, 95% CI 1.25-1.59). Patients with renal failure following heart transplantation experienced markedly higher rates of primary graft dysfunction (5% vs 1%, P<0.001) and 30-day mortality as well as lower 1- and 3-year survival compared to those without renal failure (Figure). Renal failure occurred frequently in a contemporary cohort of isolated heart transplant patients, with limited modifiable risk factors for its development. Renal-sparing strategies need to be considered in the care of heart transplant recipients with these known risk factors. Despite the increasing number of heart-kidney transplants being performed, these data suggest that additional patients may benefit from dual organ transplantation. [ABSTRACT FROM AUTHOR]

While the outcomes of ECMO as a bridge to lung transplantation have been extensively studied, little is known regarding the use of post-operative ECMO in a contemporary cohort. The purpose of the study was the determine predictors and outcomes of post-operative ECMO in a national cohort. This was a retrospective cohort study of all adult lung transplantation recipients using the 2015 to 2022 United Network for Organ Sharing database. We used multivariable logistic regression to determine covariates associated with ECMO use at 72 hours following operation. Additionally, several outcomes including post-operative stroke, acute rejection and early (30-day and in-hospital) mortality as well as 1- and 5-year survival were compared between those requiring post-operative ECMO and all other lung recipients. Of 18,014 lung transplant recipients included in analysis, 1,430 (8%) required ECMO support following transplantation. Several recipient factors were associated with increased odds of post-operative ECMO use, including female gender (adjusted odds ratio, AOR 1.28, 95% CI 1.13-1.45), high BMI (AOR 1.05/kg/m2, 95% CI 1.04-1.06), preoperative ventilation (AOR 1.61, 95% CI 1.30-2.01) or dialysis (AOR 3.89, 95% CI 2.20-6.88), elevated serum bilirubin (AOR 1.08/mg/dL, 95% CI 1.04-1.12) and donor organ ischemic time > 4 hours (AOR 1.69, 95% CI 1.39-2.06). Those requiring post-operative ECMO experienced significantly higher rates of stroke (6% vs 2%, P<0.001), acute rejection (13% vs 7%, P<0.001) and early mortality along with decreased 1- and 5-year survival (Figure), compared to others. Patients requiring ECMO at 72 hours following lung transplantation experience markedly worse early outcomes and 5-year survival compared to all other lung recipients. Identification and management of pre-, intra-, and post-operative risk factors for severe PGD requiring post-operative ECMO may improve lung transplantation outcomes. [ABSTRACT FROM AUTHOR]

Veno-venous Extra-corporeal Membrane Oxygenation (VV ECMO) has been used as a bridge to lung transplantation with acceptable outcomes. Patients with primary or secondary pulmonary arterial hypertension and/or right ventricular dysfunction have a higher risk profile and will need Veno-arterial ECMO (VA ECMO) as a bridge to lung transplantation. There is limited information on outcome of lung transplantation after VA ECMO. We hypothesized that VA ECMO, as part of a multidisciplinary ECMO program yields similar outcomes as VV ECMO as a bridge in lung transplantation. Records of all patients who had undergone ECMO with the intention to bridge to lung transplantation from January 1, 2012 to January 1, 2020 were reviewed. VV ECMO was performed via a single site dual lumen cannula or via dual peripheral cannulation sites. VA ECMO was performed via peripheral vessels or central cannulation without sternotomy. During this interval, 58 patients were placed on ECMO with the intention to bridge to lung transplantation: 27 on VV ECMO, and 31 on VA ECMO. 84% of patients on ECMO as a bridge were breathing spontaneously and ambulatory. Median duration of VV and VA ECMO were 7 days and 21 days, respectively. Incidence of ECMO-related complications were similar in the two groups. 81% of VV ECMO and 81% of VA ECMO patients underwent lung transplantation. Incidence of Primary Graft Dysfunction III at 72 hours in the VV ECMO and the VA ECMO cohorts were 0% and 4%, respectively. Median Intensive Care Unit and hospital stay of the two groups were similar. 30 days and in-hospital survival of the VV ECMO and VA ECMO groups were 100% and 96%, (p=NS). 1-year and 3-year survival of the two groups were also similar, AND did not differ when compared to the contemporary cohort of lung transplant recipients that were not bridged with ECMO. VA ECMO, as part of a multi-disciplinary ECMO team, can be used as a bridge to lung transplantation, with similar outcomes as VV ECMO. Moreover, in this selected cohort, the short and medium term survival of bridged patients is similar to non-bridged patients. [ABSTRACT FROM AUTHOR]

Purpose Extracorporeal membrane oxygenation (ECMO) is underutilized as bridge to lung transplantation (LTx) when compared to conventional mechanical ventilation (MV) in patients with end-stage lung failure. We sought to evaluate short-term outcomes in lung transplant recipients requiring preoperative advanced life support. Methods We retrospectively reviewed UNOS database to identify primary adult LTx recipients (1/2008 to 6/2017) who had no support (NO), MV, ECMO or both MV and ECMO (MVE) prior to LTx. Baseline characteristics were compared via chi-square and ANOVA. One-year survival was compared among the four groups using the Kaplan-Meier method and multivariate Cox proportional hazards regression for one-year survival was conducted to adjust for potential confounders. Results Of 16,392 recipients, there were 204 (1.2%) ECMO, 719 (4.4%) MV, and 350 (2.1%) MVE prior to transplant, with survival depicted in Fig 1. The NO cohort was older (57y) compared to MV (52y), ECMO (48y), and MVE (45y), p<.01. A majority of recipients were male, 54-60%, in each cohort. COPD was most common in the NO cohort (25%) compared to ECMO (5%), MV (17%), and MVE (1%), p<.01. IPF was the single most common diagnosis in each group, NO (37%), ECMO (39%), MV (34%), and MVE (39%). Ischemic time was longer in patients supported with MV (5.5h), ECMO (5.8h), and MVE (6.1h) compared to NO cohort (5.1h), p<.01. Single lung transplant was most common in the NO group (32%) compared to the others (6-16%), p<.01. On multivariate analysis, MV (HR 1.62, p<0.01) and MVE (HR=2.25, p<0.01) were significantly associated with worse survival while ECMO (HR 1.28, p<0.22) was not. Conclusion Short-term survival utilizing ECMO as a bridge to LTx is favorable. Further evaluation into patient selection and direct comparison to conventional MV is warranted. [ABSTRACT FROM AUTHOR]