title: Experience of extracorporeal membrane oxygenation as a bridge to lung transplantation in France.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation (LTx). However, data concerning this approach remain limited.
  
  
  METHODS
  We retrospectively reviewed the medical records of all patients in France who received ECMO as a bridge to LTx from 2007 to 2011. Post-transplant survival and associated factors were assessed by the Kaplan-Meier method and the Cox model.
  
  
  RESULTS
  Included were 36 patients from 11 centers. Indications for LTx were cystic fibrosis (CF) in 20 (56%), pulmonary fibrosis (PF) in 11 (30%), and other diagnoses in 5 (14%). ECMO was venovenous for 27 patients (75%) and venoarterial for 9 (25%). Mean follow-up was 17 months. Bridging to LTx was achieved in 30 patients (83%); however, only 27 patients (75%) survived the LTx procedure, and 20 (56%) were discharged from hospital. From ECMO initiation, 2-year survival rates were 50.4% overall, 71.0% for CF patients, 27.3% for PF patients, and 20.0% for other patients (p < 0.001). From LTx, 2-year survival rates were 60.5% overall, 71.0% for CF patients, 42.9% for PF patients, and 33.0% for other patients (p = 0.04).
  
  
  CONCLUSIONS
  Our study confirms that the use of ECMO as a bridge to LTx in France could provide a medium-term survival benefit for LTx recipients with critical conditions. Survival differed by underlying respiratory disease. Larger studies are needed to further define the optimal use of ECMO.
authors: Department of Pneumology and Lung Transplantation, Hôpital Bichat, Paris, INSERM U 700, Université Paris Diderot-Paris.
authors: Marion
authors: M
authors: Lafarge
authors: Pierre
authors: P
authors: Mordant
authors: Gabriel
authors: G
authors: Thabut
authors: Laurent
authors: L
authors: Brouchet
authors: Pierre-Emmanuel
authors: PE
authors: Falcoz
authors: Alain
authors: A
authors: Haloun
authors: Françoise
authors: F
authors: Le Pimpec-Barthes
authors: Jean-Michel
authors: JM
authors: Maury
authors: Martine
authors: M
authors: Reynaud-Gaubert
authors: Christelle
authors: C
authors: Saint-Raymond
authors: Edouard
authors: E
authors: Sage
authors: Marc
authors: M
authors: Stern
authors: Pascal
authors: P
authors: Thomas
authors: Yves
authors: Y
authors: Castier
authors: Richard
authors: R
authors: Dorent
authors: Hervé
authors: H
authors: Mal
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000098:blood supply* / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011658:Pulmonary Fibrosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*
keywords: extracorporeal membrane oxygenation; lung transplantation; outcomes.