Preliminary Experience of the Use of Extracorporeal Life Support as a Bridge to Lung Transplantation

ABSTRACT

Introduction: Several studies have demonstrated the benefits of extracorporeal life support in critically ill patients with cardiorespiratory diseases. The purpose of this study was to evaluate the preliminary experience of the use of extracorporeal life support in patients with advanced pulmonary disease on the waiting list for lung transplantation. Materials and Methods: We conducted a retrospective and descriptive analysis of patients who received extracorporeal life support as a bridge to lung transplantation or to lung transplantation candidacy between August 2010 and July 2015. Results were analyzed according to: exclusion from the waiting list, transplant candidates and number of transplants performed. We described complications and causes of mortality, and duration of extracorporeal life support, mechanical respiratory assistance and post-transplant hospitalization. Twenty-three patients were included, with a mean age of 36 ± 17 years; 61% were female. The most common diagnoses were cystic fibrosis (34.8%), idiopathic pulmonary fibrosis (30.4%) and secondary pulmonary fibrosis (13.0%). Results: Mean time on extracorporeal life support was 14.4 ± 11.7 days; veno-venous support was implemented in 14 patients, veno-arterial support in 4 cases, arterio-venous in 3, and veno-arterio-venous in 2. Eight patients did not qualify as candidates for transplantation and were excluded from the waiting list. 15 patients were accepted as a bridge for lung transplant; 8 of them died while receiving extracorporeal life support, and 7 were transplanted. After the transplantation, one patient died and 6 were discharged from the hospital with more than one year survival. Conclusion: In our series, 46.7% of candidates had access to lung transplantation under extracorporeal life support. The implementation of an effective extracorporeal life support program as a bridge to lung transplantation requires the access to new technologies and the development of the Center's team experience.