ECMO, CPB, and Off-Pump Lung Transplantation Impact on 10-Year Survival Outcomes

N. Kotler¹, M. Azuma², H. Kehara³, K. Krishan⁴, R. Yanagida⁵, M. A.. Kashem⁶, Y. Toyoda^7
1Lewis Katz School of Medicine at Temple University, Gladwyne, Pennsylvania ²LKSOM, Philadelphia, Pennsylvania ³Temple University Hospital, Philadelphia, Pennsylvania ⁴Temple University Hospital, Philadelphia, Philadelphia, Pennsylvania ⁵Temple University, Livingston, New Jersey ⁶LKSOM at Temple University, Phildelphia, Pennsylvania ⁷Temple University Hospital, Philadelphia, Pennsylvania

Purpose: While off-pump lung transplantation (LTx) is preferable in most clinical cases, often extracorporeal membrane oxygenator (ECMO) or cardiopulmonary bypass (CPB) support is indicated in selected patients. In this study, we examined the outcome of LTx patients who underwent CPB, ECMO, and Off-pump support and compared for significant differences.

Methods: We retrospectively evaluated all lung transplant data from a single institution from February 2012 to May 2024 (n=1207). Patients were grouped by usage of no pump (Off-pump), CPB, or ECMO during surgery and those who used a combination of the two (CPB/ECMO; n=10) were excluded. Demographics and clinical variables such as patient age, sex, BMI, ethnicity, lung allocation score (LAS), surgical approach, warm ischemic time, post-op ECMO, and length of stay (LOS) were compared in the three groups. Within each group, the same comparison was done for single and double lung transplantation (SLTx and DLTx). Survival was assessed using Kaplan-Meier curve and log-rank tests were analyzed using JMP Inc. (version 17.0). P-value < 0.05 was considered to be significant.

Results: The Off-pump group had the highest average patient age (p <.0001). For all groups, patient sex (p=.1456) was insignificant. The CPB group had the highest average BMI (p=.0109). Off-pump had the highest percentage of white recipients (p=.0019). CPB had the highest average LAS (p= <.0001). Off-pump had the largest percentage of antero-axillary surgical approaches (p= <.0001). Warm ischemic times for the left and right lungs were insignificant (p=.0539 and p=.3413). CPB had the highest average LOS (p= <.0001), and the highest percentage of postop ECMO (p= <.0001). Kaplan-Meir survival curve at 10 years revealed no significant difference between ECMO compared to the Off-pump group (p=.8530). There were no significant differences between survival outcomes for SLTx vs. DLTx for the ECMO (p=.1136), CPB (p=.1028), and Off-pump groups (p=.4846). There was a significant difference in 10-year survival between patients treated with ECMO vs. CPB (p=.0087) and patients treated with CPB vs. Off-pump (p=.0017). A Kaplan Meir test comparing all three groups found a significant difference for 10-year survivability (p=.0048).

Conclusion: The results suggest that ECMO and Off-pump lung transplantation have better survival outcomes than procedures using CPB, regardless of SLTx or DLTx. These findings suggest that when bypass must be used in surgery, ECMO is preferable to CPB in selected patients.

Identify the source of the funding for this research project: Federal Work Study Grant