• Konrad Hoetzenecker, Laura Donahoe, Jonathan C Yeung, Sassan Azad, Eddy Fan, Niall D Ferguson, Lorenzo Del Sorbo, Marc de Perrot, Andrew Pierre, Kazuhiro Yasufuku, Lianne Singer, Thomas K Waddell, Shaf Keshavjee, and Marcelo Cypel.
• Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
• J. Thorac. Cardiovasc. Surg. 2018 Mar 1; 155 (3): 1316-1328.e1.

ObjectivesExtracorporeal life support (ECLS) is increasingly used to bridge deteriorating patients awaiting lung transplantation (LTx), however, few systematic descriptions of this practice exist. We therefore aimed to review our institutional experience over the past 10 years.MethodsIn this case series, we included all adults who received ECLS with the intent to bridge to LTx. Data were retrieved from patient charts and our institutional ECLS and transplant databases.ResultsBetween January 2006 and September 2016, 1111 LTx were performed in our institution. ECLS was used in 71 adults with the intention to bridge to LTx; of these, 11 (16%) were bridged to retransplantation. The median duration of ECLS before LTx was 10 days (range, 0-95). We used a single dual-lumen venous cannula in 23 patients (32%). Nine of 13 patients (69%) with pulmonary hypertension were bridged by central pulmonary artery to left atrium Novalung. Twenty-five patients (35%) were extubated while on ECLS and 26 patients (37%) were mobilized. Sixty-three patients (89%) survived to LTx. Survival by intention to treat was 66% (1 year), 58% (3 years) and 48% (5 years). Survival was significantly shorter in patients undergoing ECLS bridge to retransplantation compared with first LTx (median survival, 15 months (95% CI, 0-31) versus 60 months (95% CI, 37-83); P = .041).ConclusionsIn our center experience, ECLS bridge to first lung transplant leads to good short-term and long-term outcomes in carefully selected patients. In contrast, our data suggest that ECLS as a bridge to retransplantation should be used with caution.Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

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