10-Year Experience with Postoperatively-Extended Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Severe Pulmonary Hypertension.

At our institution, since early 2010, patients with severe pulmonary hypertension have been transplanted using a protocol based on postoperative extension of intraoperatively-started veno-arterial extracorporeal membrane oxygenation (vaECMO) support. Here we present our 10-year experience with bilateral lung transplantation using vaECMO support in patients with severe pulmonary hypertension. Records of patients transplanted at our institution between January 2010 and October 2020 were retrospectively reviewed. Prevalence of primary graft dysfunction (PGD) and ventilation time were compared between patients transplanted for severe pulmonary hypertension vs. patients transplanted for other indications (control group), using Chi-Square test and Mann-Whitney U test, respectively. Graft survival and freedom from chronic lung allograft dysfunction (CLAD), were compared between groups using Kaplan-Meyer analysis with the log-rank test. During the study period, among the 1288 lung transplanted patients at our institution, 85 (6.2%) patients were transplanted for sPAH and 1201 (93.8%) patients for other indications. Patients with severe pulmonary hypertension were younger than control patients (31 vs. 47 years, p<0.0001). Prevalence of PGD grade 3 was higher in sPHT than in the control group at 24h (22% vs. 5%; p<0.0001), 48h (23% vs 5%; p<0.0001) and 72h (24 vs. 4%; p<0.0001). Mean postoperative ventilation time was significantly longer in sPHT than in the control group (11.4 vs. 3.5 days; p<0.0001). 1-, 5- and 10-year overall patient and graft survival (86% vs. 90%, 68% vs. 70%, 54% vs. 57% p=0.769), freedom from CLAD during follow up (97% vs. 96%, 75% vs. 67%, 60% vs. 52% p=0.391) and survival conditioned to hospital discharge (94% vs. 95%, 80% vs. 76%, 69% vs. 64% p=0.328) did not differ between sPHT and control patients. A protocol based on postoperatively-extended intraoperative ECMO support allows safe transplantation of sPHT patients. Despite increased morbidity in the early postoperative period, long-term survival and freedom from CLAD do not differ compared to patients who were transplanted for other indications. [ABSTRACT FROM AUTHOR]