title: Awake extracorporeal membrane oxygenation bridging for pulmonary retransplantation provides comparable results to elective retransplantation.
abstract: BACKGROUND
  Lung retransplantation became an accepted treatment for bronchiolitis obliterans syndrome (BOS). However, the value of different bridging modalities for these patients is controversial.
  
  
  METHODS
  We analyzed outcomes of 39 patients listed for retransplantation between 2008 and 2012. Patients were divided in 3 groups: 23 patients without any bridge modality (elective, Group 1), 11 patients on ventilation and full sedation with or without extracorporeal membrane oxygenation (ECMO) support (sedated bridging, Group 2), and 5 patients awake on ECMO support (awake bridging, Group 3).
  
  
  RESULTS
  Waiting list mortality was 13% in Group 1, 39% in Group 2, and 0% in Group 3. Perioperative mortality was 20% in Group 1, 29% in Group 2, and 0% in Group 3. Significant differences between Groups 1 and 2 were calculated for time on post-operative ventilation (17.4 vs 27.3 days, p = 0.022), intensive care unit stay (22.0 vs 32.9 days, p = 0.026), and hospital stay (34.7 vs 54.1 days, p = 0.013). However, there were no significant differences between Groups 1 and 3 for post-operative ventilation time (17.4 vs 13.4 days, p = 0.192), for intensive care unit stay (22.0 vs 26.4 days, p = 0.169), or for hospital stay (34.7 vs 34.8 days, p = 0.367). Survival rates at 90 days, 1 year, and 2 years were 80%, 70%, and 53% in Group 1; 71%, 43%, and 29% in Group 2; and 100%, 60%, and 60% in Group 3, respectively.
  
  
  CONCLUSIONS
  Awake ECMO bridging for retransplantation provides comparable results to elective retransplantation.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gyoergy
authors.initials: G
authors.lastname: Lang
authors.affiliation: Department of Thoracic and Cardio-vascular Surgery, Veterans Health Service Medical Center, Seoul, Korea. Electronic address: mdksr@paran.com.
authors.forename: Doosang
authors.initials: D
authors.lastname: Kim
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Jose
authors.initials: J
authors.lastname: Matila
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Murakoezi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000601:surgery*; D002648:Child; D003243:Consciousness; D054810:Deep Sedation; D017558:Elective Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: BOS; ECMO; Lung transplantation; bridging; iLA