title: Primary lung transplantation after bridge with extracorporeal membrane oxygenation:  a plea for a shift in our paradigms for indications.
abstract: BACKGROUND
  The introduction of the lung allocation score has brought lung transplantation (LTX) of patients on extracorporeal membrane oxygenation (ECMO) bridge into the focus of interest. We reviewed our institutional experience with ECMO as a bridge to LTX.
  
  
  METHODS
  Between 1998 and 2011, 38 patients (median age 30.1 years, range 13-66 years) underwent ECMO support with intention to bridge to primary LTX. The underlying diagnosis was cystic fibrosis (n=17), pulmonary hypertension (n=4), idiopathic pulmonary fibrosis (n=9), adult respiratory distress syndrome (n=4), hemosiderosis (n=1), bronchiolitis obliterans (n=1), sarcoidosis (n=1), and bronchiectasis (n=1). The type of extracorporeal bridge was venovenous (n=18), venoarterial (n=15), interventional lung assist (n=1), or a stepwise combination of them (n=4). The median bridging time was 5.5 days (range 1-63) days. The type of transplantation was double LTX (n=7), size-reduced double LTX (n=8), lobar LTX (n=16), split LTX (n=2), and lobar LTX after ex vivo lung perfusion (n=1).
  
  
  RESULTS
  Four patients died before transplantation. Thirty-four patients underwent LTX, of them eight patients died in the hospital after a median stay of 24.5 days (range 1-180 days). Twenty-six patients left the hospital and returned to normal life (median hospital stay=47.5 days; range 21-90 days). The 1-, 3-, and 5-year survival for all transplanted patients was 60%, 60%, and 48%, respectively. The 1-, 3-, and 5-year survival conditional on 3-month survival for patients bridged with ECMO to LTX (78%, 78%, and 63%) was not worse than for other LTX patients within the same period of time (90%, 80%, and 72%, respectively, P=0.09, 0.505, and 0.344).
  
  
  CONCLUSIONS
  Transplantation of patients bridged on ECMO to LTX is feasible and results in acceptable outcome.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. gyoergy.lang@meduniwien.ac.at
authors.forename: György
authors.initials: G
authors.lastname: Lang
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Taghavi
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
authors.forename: Ferenc
authors.initials: F
authors.lastname: Rényi-Vámos
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.forename: Victoria
authors.initials: V
authors.lastname: Augustin
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagayama
authors.forename: Bahil
authors.initials: B
authors.lastname: Ghanim
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001317:Austria; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult