Lung Transplantation in Patients with Severe Pulmonary Hypertension: a 13-Year Single-Center Experience

Background: Patients with severe pulmonary hypertension (PH) may hemodynamically deteriorate during waiting list time and require extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx). In this retrospective single-center study, we present our 13-year experience with LTx in PH patients.

Methods: Patients with severe PH as indication to transplantation, who were listed for LTx between January 2010 and March 2023, were included into the study. All transplanted patients were sub-divided into bridged and nonbridged patients and further compared in regards to intraoperative and early posttransplant course. Bridged patients were also sub-divided into short-term ECMO support (≤14 days) and long-term ECMO support (>14 days). Adult PH patients were stratified according to the Comparative Prospective Registry of Newly Initiated Therapies (COMPERA) risk score 2.0.

Results: Among the 123 included PH patients, 9 (7%) died while on the waiting list (on ECMO, n = 4) and 114 (93%) patients were transplanted (ECMO bridging n = 28; no ECMO bridging n = 86). Median duration of ECMO bridging was 16 [5–28] days. Transplanted patients bridged with ECMO exhibited more complicated peri- and early posttransplant courses compared with nonbridged patients shown in more required packed red cells (p = 0.003) and platelet transfusions (p = 0.048) during index admission. Furthermore, bridged patients suffered more ECMO-related vascular complications (p = 0.031), required more re-thoracotomy due to bleeding (p = 0.049) and had longer intensive care unit (ICU) stays post-LTx (p = 0.002). Long-term bridged patients suffered more ECMO-related vascular complications compared with short-term bridged patients (p = 0.037). However, 1-, 5- and 8-year graft survival did not differ significantly between bridged and nonbridged patients (82% vs. 88%, 54% vs. 59%, 46% vs. 47%, p = 0.84). Similarly, graft survival did not differ according to the COMPERA risk score (low risk n = 1, intermediate-low risk n = 10, intermediate-high risk n = 23, high risk n = 47; p = 0.41).

Conclusion: ECMO bridging in PH did not affect graft survival after LTx. Bridged patients however endured significantly more complicated peri-transplant courses. Therefore, transplantation before need of ECMO bridging will prevent unnecessary complications and save hospital resources. Thus, patients at high risk should be prioritized in organ allocation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024