Advanced Lung Failure and TransplantationNew OPTN/UNOS data demonstrates higher than previously reported waitlist mortality for lung transplant candidates supported with ECMO
Section snippets
Population
All lung transplant candidates listed for lung transplant from May 1, 2016 to June 1, 2020 were identified using data from the Scientific Registry of Transplant Recipients (SRTR).9 The SRTR data system includes data on all donors, waitlisted candidates, and transplant recipients in the US, submitted by the members of the OPTN. The Health Resources and Services Administration, US Department of Health and Human Services provides oversight to the activities of the OPTN and SRTR contractors.
Case adjudication
There were 12,386 lung listings for 11,985 unique lung transplant candidates. After excluding pediatric (N = 246) and multi-organ listings (N = 247), there were 11,492 candidates. 379 candidates had ECMO documented at the time of waiting list placement, and 488 with ECMO implantation between listing and transplant (Total N = 867). 62 candidates had missing ECMO implantation dates and were only included in the waitlist sensitivity analysis and post-transplant survival analyses. Of the 867
Principal findings
Through a detailed case identification process using data newly collected by OPTN/UNOS, we found that ECMO bridging to transplant is more prevalent than previously reported, identifying an additional 28.5% of candidates that were missed using previously available ECMO data. The candidates bridged to transplant with ECMO experienced a 23.9-fold increased risk of becoming too sick to transplant or death yet only experienced a 4.08-fold increased likelihood of receiving a transplant, a discordance
Conclusions
Due to structural changes in ECMO data collection, it is now possible to accurately classify candidates requiring ECMO at all points on the waiting list, allowing for accurate estimation of the waitlist and post-transplant mortality and more accurate predictions of transplant benefit in this population. We found that candidates on ECMO are likely to experience considerable transplant benefit with a high risk of waitlist mortality and relatively well-preserved post-transplant survival; however,
Author Contributions
All authors meet all four ICMJE criteria for authorship. CJL, JS, and MV designed the study, JS acquired the data, JS and SA completed the analysis, and CJL, JS, SA, and MV interpreted data for the work. All authors had full access to data, collaborated to produce the final draft, and accept responsibility to submit for publication.
Acknowledgments
The authors would like to thank Theresa Garcia, MNA, for providing a detailed description of the clinical data entry process for US candidates bridged to transplant with ECMO. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or
References (22)
- et al.
Development of the new lung allocation system in the United States
Am J Transpl
(2006) - et al.
Organ allocation
- et al.
OPTN/SRTR 2020 annual data report: lung
Am J Transpl
(2022) - et al.
Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation
J Heart Lung Transpl
(2021) - et al.
Waitlist mortality and extracorporeal membrane oxygenation as a bridge to lung transplantation
J Heart Lung Transpl
(2019) - et al.
Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease
J Thorac Cardiovasc Surg
(2015) - et al.
Mechanical ventilation and extracorporeal membrane oxygenation as a bridging strategy to lung transplantation: significant gains in survival
Am J Transpl
(2018) - et al.
The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult lung transplantation report—2021; focus on recipient characteristics
J Heart Lung Transpl
(2021) - et al.
Scientific Registry of Transplant Recipients: collecting, analyzing, and reporting data on transplantation in the United States
Transpl Rev
(2013) - et al.
Extremes of age decrease survival in adults after lung transplant
Chest
(2020)
Trends in U.S. extracorporeal membrane oxygenation use and outcomes: 2002-2012
Semin Thorac Cardiovasc Surg
Cited by (0)
This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health (Dr Lehr with K08HL159236 and Cystic Fibrosis Foundation 004235A122 and Dr Valapour with R01HL153175) and a research grant from the Cleveland Clinic Center for Populations Health Research.
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Twitter: @CarliLehrMDPhD, @MValapour