INTRODUCTION
In patients with end-stage lung disease awaiting lung transplantation
(LTx), waiting list mortality remains high due to the shortage of
available donor organs and the risk of acute respiratory failure in many
patients on the transplant list. Recent reports have demonstrated that
mechanically ventilated lung recipients have significantly higher
post-transplant mortality when compared to non-ventilated
recipients.1-3
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is
increasingly being used to bridge acutely deteriorating candidates to
LTx as it can allow critically ill recipients to remain eligible for LTx
while reducing pretransplant deconditioning.4-8 In
particular, VV-ECMO as a bridge to transplantation (BTT) can facilitate
early ambulation, thus improving their condition, and may mitigate
detrimental intensive care unit (ICU) complications including weakness,
delirium, and ventilator-associated pneumonia or lung
injury.4 However, a decade ago few reports have raised
skepticism for this strategy as they have suggested a negative effect of
bridging with ECMO on post-transplant survival.2,9Since then, there is a growing evidence from high-volume and experienced
lung transplant centers that BTT strategy using ECMO can provide
satisfactory outcomes.10-14
In the present study, our aim was to analyze postoperative outcomes of
patients on VV-ECMO as a BTT and the impact of preoperative VV-ECMO on
posttransplant survival outcomes. Early and mid-term outcomes of BTT
patients were evaluated and compared after matching with non-bridged LTx
recipients. In order to achieve the best possible matching between both
subgroups, we have performed optimal full matching based on Mahalanobis
distance and sensitivity analysis.