Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO) registry.

BACKGROUND: Some patients with severe primary graft dysfunction (PGD) after lung transplantation (LTx) require gas exchange support using an extracorporeal membrane oxygenator (ECMO) as a life-saving therapy. A few single-center experiences have been reported with relatively few cases of ECMO after LTx.
METHODS: We reviewed outcomes of ECMO in lung transplant recipients included in the Extracorporeal Life Support Organization (ELSO) registry, which was established with the intention to improve quality and outcome of extracorporeal life support (ECLS) in patients treated with ECMO applied for all indications.
RESULTS: The ELSO registry currently includes 31,340 ECMO cases, of which 151 were post-LTx patients with primary graft dysfunction (PGD). The mean age was 35 +/- 18 years. Indications for LTx were acute respiratory distress syndrome, (15%), cystic fibrosis (15%), idiopathic pulmonary fibrosis (8%), primary pulmonary hypertension, (10%), emphysema (15%), acute lung failure (11%), other (23%), and unknown (3%). ECMO run time was 140 +/- 212 hours. Venovenous ECMO was used in 25, venoarterial in 89, and other modes in 15 patients (unknown in 22). ECMO was discontinued in 93 patients owing to lung recovery. It was also discontinued in 29 patients with multiorgan failure, in 22 patients that died with no further specification, and in 7 patients for other reasons. In total, 63 (42%) patients survived the hospital stay. Major complications during ECMO included hemorrhage (52%), hemodialysis (42%), neurologic (12%), and cardiac (28%) complications, inotropic support (77%), and sepsis (15%).
CONCLUSIONS: Although the ELSO registry was not primarily established to study ECMO in LTx, it provides valuable insights and evidence that there is indeed an appreciable salvage rate with the use of ECMO for PGD after LTx. Clearly, this is a very high-risk patient population, and no single center can accumulate a large experience of ECMO for this specific indication. These data, however, underscore the importance of developing a specific registry for patients put on ECLS devices so that we can better study the outcomes, determine optimum treatment strategies, and optimize patient and device selection, and thus improve the outcomes of patients requiring this unique therapy.