Survival After Extracorporeal Membrane Oxygenation Bridge to Lung Retransplantation

Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Despite success in select populations, candidates requiring ECMO bridge to retransplantation have historically had poor 1-year survival. This study aimed to examine the characteristics of the recipient, donor, and transplant procedure type to guide selection of candidates for ECMO bridge to retransplantation. This was a retrospective cohort study of all US adult lung retransplant recipients between May 5, 2005, and December 31, 2022. We evaluated 1-year survival of ECMO-bridged retransplant patients, stratified by time from initial transplant, procedure type (single or bilateral retransplant), and ECMO era (2005-2017 vs 2018-2022). In this national cohort, 111 of 1296 (8.6%) retransplant recipients underwent ECMO bridge. One-year survival was worse for ECMO bridge retransplant recipients (52.2% vs 74.0%; P <.001) and has worsened in the contemporary era (2018-2022) of ECMO bridge to retransplantation compared with prior years ( P  =.03). Time from initial transplantation and use of bilateral retransplant after an initial bilateral transplant were most strongly associated with improved 1-year survival of ECMO-bridged retransplant recipients. Of bilateral recipients bridged to bilateral transplant more than 1 year after primary transplantation, survival was 65.9% in ECMO-bridged patients as opposed to 77.2% in nonbridged patients. Careful selection of candidates and surgical procedure type remains essential in determining candidacy for ECMO bridge to retransplantation.