title: Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults.
abstract: Patients supported with extracorporeal membrane oxygenation (ECMO) are given priority listing status for heart transplant (HT). Data on post-HT outcomes for adults with ECMO support at the time of HT are limited.
  
  
  
  We analyzed data from the United Network for Organ Registry (UNOS) registry for 157 ECMO-supported adults (age ≥ 18 years) undergoing HT after January 1, 2000. Data at the time of HT were examined for their association with post-transplant mortality using multivariable Cox proportional hazard analyses.
  
  
  
  Patients (69.4% males; mean age, 46.0 ± 15.6 years; 15.9% African Americans) were monitored for median of 0.55 years (interquartile range, 0.04-4.5). Seventy patients (44.6%) died during follow-up (survival at 1 year was 57.8%), of which 43 (61.4%) died within 30 days post-HT. For patients surviving the first 30 days after transplant, long-term survival was acceptable (82.3% at 1 year and 76.2% at 5 years). Prevalence of immediate post-HT complications, such as stroke and need for dialysis, were 10.1% and 28.1%, respectively. Post-HT survival did not differ between those who received an allograft before and after January 1, 2009 (univariate hazard ratio, 0.84; 95% confidence interval, 0.51-1.38; p = 0.48). Among the predictors identified for 30-day and long-term mortality were recipient history of renal insufficiency (RI; defined as estimated glomerular filtration rate < 45 ml/min/1.73 m2or dialysis) and mechanical ventilation (MV; interaction p < 0.05); those with both MV and RI had significantly poorer post-transplant survival (29.4% and 12.5% for 30-day and 1-year survival, respectively) compared with those without (78.7% and 71.4% for 30-day and 1-year survival, respectively).
  
  
  
  Post-HT mortality did not change for ECMO-supported adults in the contemporary era, and those with RI and MV had significantly poorer post-transplant survival. A critical review of priority listing status for ECMO-supported patients is warranted for optimal allocation and outcomes of cardiac allografts.
authors.affiliation: Division of Advanced Heart Failure, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: sandip.zalawadiya@gmail.com.
authors.forename: Sandip
authors.initials: S
authors.lastname: Zalawadiya
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Duke University Hospital, Durham, North Carolina.
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.affiliation: Division of Advanced Heart Failure, Advocate Christ Medical Center, Chicago, Illinois.
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
authors.affiliation: Division of Advanced Heart Failure, Advocate Christ Medical Center, Chicago, Illinois.
authors.forename: William
authors.initials: W
authors.lastname: Cotts
authors.affiliation: Division of Advanced Heart Failure, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lindenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: extracorporeal membrane oxygenation; heart transplant; mechanical ventilation; mortality; renal insufficiency