title: Extracorporeal Life Support as Bridge to Lung Retransplantation: A Multicenter Pooled Data Analysis.
abstract: BACKGROUND
  Extracorporeal life support (ECLS) as a bridge to lung retransplantation has been reported only anecdotally. Thus, we analyzed combined data from our center with pooled data from published studies to identify selection criteria for this advanced therapy.
  
  
  METHODS
  Four patients at our center were bridged on ECLS to lung retransplantation. Patient data were retrospectively retrieved from electronic records. The MEDLINE database was searched using the PubMed engine and yielded 13 relevant studies that included a minimum of 3 patients bridged to lung retransplantation, and four studies described detailed data on 17 patients. Patient data from our center (n = 4) were pooled with data from the MEDLINE database (n = 17) and analyzed.
  
  
  RESULTS
  Of 21 patients, 3 (14%) died on ECLS awaiting retransplantation, and 18 (86%) underwent retransplantation after a median of 37 months (range, 0 to 168 months) after primary transplantation. Type of ECLS was extracorporeal carbon dioxide removal (ECCO2R) in 4, venovenous extracorporeal membrane oxygenation (ECMO) in 7, venoarterial ECMO in 5, or was not mentioned in 2. The 90-day postoperative mortality was 28%. Overall 1-year survival was 48%. Patients bridged to retransplantation with ECCO2R/venovenous ECMO (p = 0.05) or on awake ECMO (p = 0.06) showed strong trends toward better survival in univariate analysis. Univariate and multivariate analysis identified a longer intertransplant interval as a statistically significant favorable prognostic factor. In a selected subgroup of patients (awake ECCO2R/venovenous ECMO support and intertransplant interval >2 years), 1-year survival reached 67%.
  
  
  CONCLUSIONS
  Despite limited overall 1-year survival for patients bridged with ECLS to lung retransplantation, careful patient selection may yield an acceptable 1-year survival of 67%.
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Collaud
authors.affiliation: Division of Pulmonary Medicine, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Division of Medical Intensive Care Unit, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ganter
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Opitz
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Schneiter
authors.affiliation: Division of Surgical Intensive Care Unit, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Schuepbach
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.affiliation: Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland. Electronic address: walter.weder@usz.ch.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D015337:Multicenter Studies as Topic; D018579:Patient Selection; D012086:Reoperation