BACKGROUND Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood. METHODS The United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other non-ECMO mechanical circulatory support, Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged. RESULTS Of 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p < 0.001). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between ECMO and non-ECMO patients (p = 0.82). CONCLUSIONS ECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.

中文翻译：

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体外膜肺氧合作为胸腔多器官移植的桥梁。


背景体外膜肺氧合 （ECMO） 已成为多器官衰竭患者护理的重要工具，并越来越多地用作移植的桥梁。虽然已经描述了 ECMO 作为离体心肺移植桥梁的数据，但我们将 ECMO 作为胸部多器官移植桥梁的新经验尚不清楚。方法 使用器官共享联合网络数据库来确定 1987 年至 2022 年间接受胸部多器官移植的成年患者。排除标准是受者年龄 <18 并与其他非 ECMO 机械循环支持桥接，进行生存分析以比较通过 ECMO 桥接移植的患者与未桥接的患者之间的结果。结果 在 3,927 例接受胸部多器官移植的患者中，共有 203 例 （5.2%） 患者接受了 ECMO 作为移植的过渡。在 ECMO 接受者中，患者最常桥接至心肺 （45.8%），其次是心肾 （34.5%） 和肺肾移植 （11.8%）。在中位随访 35.5 个月时，与未桥接的多器官移植受者相比，经 ECMO 桥接的患者的未调整生存期降低 （p < 0.001）。在移植后存活超过 30 天的患者中，ECMO 和非 ECMO 患者的条件长期生存率相似 （p = 0.82）。结论 ECMO 越来越多地用作胸部多器官移植的桥梁，并与 30 天死亡率增加和长期生存率降低相关。在移植后存活至 30 d 的特定患者中，使用 ECMO 桥接的患者与未桥接的患者之间的长期生存率相似。