title: Extracorporeal membrane oxygenation and retransplantation in lung transplantation: an analysis of the UNOS registry.
abstract: BACKGROUND
  Despite limited organ availability, extracorporeal membrane oxygenation (ECMO) and retransplantation are becoming more commonplace.
  
  
  METHODS
  Using the United Network for Organ Sharing (UNOS) database, we evaluated survival of patients treated with ECMO before lung transplantation and undergoing retransplantation. A query identified cadaveric recipients from 2001 to 2012 over the age of 6 years.
  
  
  RESULTS
  Of 15,772 lung recipients, 15 583 never received ECMO, whereas 189 did. Mean age was 52.1 ± 14.4 versus 46.8 ± 16.5 years for non-ECMO and ECMO groups, respectively (p < 0.0001). Using Kaplan-Meier method, there were survival differences between ECMO and non-ECMO groups (p < 0.0001) and first-time transplants with and without ECMO to retransplants with and without ECMO (p < 0.0001). The proportional hazards model identified higher risk with ECMO use in idiopathic pulmonary fibrosis (hazard ratio [HR] 1.09; 95 % confidence interval (CI), 1.02-1.17; p = 0.014) and retransplants (HR 1.77; 95 % CI, 1.55-2.03; p < 0.0001).
  
  
  CONCLUSIONS
  Survival for retransplantation was similar to ECMO as a primary option with significant mortality associated with ECMO use in patients with idiopathic pulmonary fibrosis and retransplants.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA, hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.forename: Robert S
authors.initials: RS
authors.lastname: Higgins
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.forename: Stephen
authors.initials: S
authors.lastname: Kirkby
authors.forename: Amy L
authors.initials: AL
authors.lastname: Pope-Harman
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Preston
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome