title: Use of Extracorporeal Membrane Oxygenation Prior to Lung Transplantation Does Not Jeopardize Short-term Survival.
abstract: BACKGROUND
  The use of pretransplantation extracorporeal membrane oxygenation (ECMO) has been considered to be a relative contraindication and a risk factor associated with poor outcomes in lung transplantation. However, with a donor shortage, use of ECMO before transplantation is often unavoidable. This study aimed to review our experiences of lung transplantation outcome with regards to the use of pretransplantation ECMO.
  
  
  METHODS
  We retrospectively reviewed the clinical data of patients who underwent lung transplantation at our institution. Clinical variables as well as ECMO-related data were analyzed with surgical outcomes.
  
  
  RESULTS
  From 2006 to 2014, 27 patients underwent lung transplantation: 26 bilateral sequential lung transplants and 1 right-side single lung transplant. Of these, 12 (44.4%) received ECMO treatment during the pretransplantation waiting period. Pretransplantation ECMO patients showed higher body mass index scores (P = .047) and mechanical ventilation support (P < .001) than the non-ECMO group. All ECMO patients were weaned from ECMO after transplantation. The median ECMO runtime was 12 days. The survival-to-discharge rates of the 2 groups did not differ. Survival after lung transplantation at 1, 6, 12, and 24 months was 100%, 73.3%, 61.1%, and 61.1% in the ECMO group and 100%, 86.7%, 86.7%, and 66.0% in the non-ECMO group, respectively (P = .540).
  
  
  CONCLUSIONS
  Use of pretransplantation ECMO did not jeopardize survival-to-discharge and short-term survival rates in our experience. Our result suggests pretransplantation ECMO can provide a chance of receiving lung transplantation to those who were classified as "too sick to be transplanted."
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Transplantation Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Transplantation Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Transplantation Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: H Y
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: I K
authors.initials: IK
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: C H
authors.initials: CH
authors.lastname: Kang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Y W
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Transplantation Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: ytkim@snu.ac.kr.
authors.forename: Y T
authors.initials: YT
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000075202:Contraindications; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome