title: Influence of age on survival in adult patients on extracorporeal membrane oxygenation before lung transplantation.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is widely accepted as a means of support before lung transplantation (LTx), but limited data exist regarding its impact on long-term survival in association with patient age and covariates that may be influencing clinical outcomes.
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database was queried from 2000 to 2013 for adult recipients (≥18 years) to assess the impact of age on survival in patients on ECMO before LTx.
  
  
  RESULTS
  From a total 17,556 adult lung recipients, 17,441 were included for univariate and Kaplan-Meier function analysis, 15,553 for multivariate Cox models and 364 for propensity score matching. Univariate (HR = 1.804, 95% CI 1.441-2.258, p < 0.001) and multivariate (HR = 1.845, 95% CI 1.450-2.347, p < 0.001) Cox models identified a survival difference between ECMO and no ECMO, which was confirmed by propensity score matching (HR = 2.500, 95% CI 1.525-4.099, p < 0.001). Sub-group analysis demonstrated that younger age (<40 years) was not associated with a significantly increased risk of death, whereas older age (≥60 years) was by univariate (HR = 2.373, 95% CI 11.600-3.518, p < 0.001) and multivariate (HR = 2.364, 95% CI 1.566-3.568, p < 0.001) Cox models when comparing ECMO vs no ECMO. This effect associated with older age was confirmed by propensity score matching (HR = 3.000, 95% CI 1.191-7.558, p = 0.020).
  
  
  CONCLUSIONS
  Although ECMO adversely impacted survival in a contemporary cohort of adult lung transplant recipients, the negative effect centered on older patients.
authors: Departments of Pediatrics; Internal Medicine and; Collaboration for Organ Perfusion, Protection, Engineering and Regeneration Laboratory, The Ohio State University; Section of Pulmonary Medicine, Nationwide Children's Hospital. Electronic address: hayes.705@osu.edu.
authors: Don
authors: D
authors: Hayes
authors: Collaboration for Organ Perfusion, Protection, Engineering and Regeneration Laboratory, The Ohio State University; Department of Surgery, The Ohio State University.
authors: Bryan A
authors: BA
authors: Whitson
authors: Collaboration for Organ Perfusion, Protection, Engineering and Regeneration Laboratory, The Ohio State University; Department of Surgery, The Ohio State University.
authors: Sylvester M
authors: SM
authors: Black
authors: Departments of Pediatrics; Collaboration for Organ Perfusion, Protection, Engineering and Regeneration Laboratory, The Ohio State University; Department of Cardiovascular Perfusion, Nationwide Children's Hospital.
authors: Thomas J
authors: TJ
authors: Preston
authors: Department of Anesthesiology, The Ohio State University.
authors: Thomas J
authors: TJ
authors: Papadimos
authors: Department of Anesthesiology, The Ohio State University; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors: Joseph D
authors: JD
authors: Tobias
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: adult; age; extracorporeal membrane oxygenation; lung transplantation; organ procurement; survival