What question did this study set out to answer?

The aim is to assess the impact of ECMO on transfusion requirements and early postoperative outcomes in lung transplant recipients.

March 26, 2026

927: Ecmo as Bridge to Lung Transplant: Transfusion Burden and Post-Transplant Outcomes

Key Points

The aim is to assess the impact of ECMO on transfusion requirements and early postoperative outcomes in lung transplant recipients.
Retrospective analysis of 306 adult lung transplant recipients from 2018 to 2024
Comparison of intraoperative transfusion volumes between ECMO and non-ECMO patients
Assessment of early postoperative outcomes, including rates of primary graft dysfunction and ICU stay
Use of multivariable logistic regression to determine predictors of primary graft dysfunction.
ECMO patients required significantly higher volumes of red blood cells, fresh frozen plasma, platelets, and cryoprecipitate preoperatively and intraoperatively.
Postoperative red blood cell transfusions remained elevated in ECMO patients, although FFP and platelet use did not differ significantly.
Higher rates of primary graft dysfunction were observed in ECMO patients (37.1% vs. 21.8%).
A significantly higher percentage of ECMO patients required kidney replacement therapy and had longer ICU stays.

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation but may increase transfusion needs and impact postoperative outcomes. This study compared intraoperative transfusion burden and early post-transplant outcomes in patients with and without ECMO support. Methods: We retrospectively analyzed 306 adult lung transplant recipients at a single tertiary center (2018–2024), including 35 patients (11.4%) who received ECMO as a bridge to transplantation. We compared intraoperative transfusion volumes and early postoperative outcomes between ECMO-bridged and non-bridged groups. Multivariable logistic regression was used to identify independent predictors of primary graft dysfunction (PGD). Results: Patients bridged with ECMO had significantly higher transfusion requirements across all perioperative phases. Preoperatively, ECMO patients received higher volumes of RBCs (7.60 ± 6.90 vs. 0.09 ± 0.44 units; p < 0.001), FFP (2.54 ± 6.47 vs. 0.26 ± 1.82; p = 0.045), platelets (0.97 ± 1.93 vs. 0.02 ± 0.26; p = 0.006), and cryoprecipitate (2.03 ± 4.57 vs. 0.0004 ± 0.06; p = 0.013). Intraoperative transfusions was also significantly higher for RBCs (8.63 ± 5.50 vs. 2.80 ± 3.76; p < 0.001), FFP (4.43 ± 5.88 vs. 1.27 ± 2.55; p < 0.01), platelets (2.80 ± 2.65 vs. 0.68 ± 1.60; p < 0.001), and cryoprecipitate (1.74 ± 2.59 vs. 0.56 ± 1.25; p = 0.01). Postoperatively, RBC transfusion remained elevated in ECMO patients (9.03 ± 8.60 vs. 4.77 ± 8.63; p < 0.01), while FFP and platelet use did not differ significantly. ECMO patients showed higher rates of PGD (37.1% vs. 21.8%; p = 0.056), kidney replacement therapy at 24 hours (51.4% vs. 16.6%; p < 0.001), and longer ICU stays (median 55 vs. 10 days; p < 0.001). On multivariable analysis, only preoperative transfusion was independently associated with PGD (AOR = 10.02; 95% CI: 1.76–57.17; p = 0.01). Conclusions: ECMO as a bridge to lung transplantation is linked to substantially increased transfusion burden and more complex postoperative courses. Preoperative transfusion was identified as an independent predictor of primary graft dysfunction. These findings highlight the importance of meticulous transfusion management and perioperative optimization in this high-risk group.

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927: Ecmo as Bridge to Lung Transplant: Transfusion Burden and Post-Transplant Outcomes

Key Points

Abstract

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