Impact of preoperative venovenous extracorporeal membrane oxygenation bridging on postoperative acute kidney injury after lung transplantation.

Authors

Rachel Reichenbach, Yudai Miyashita, Taichi Nagano, Taisuke Kaiho, Yuriko Yagi, Ankit Bharat, G R Scott Budinger, Ambalavanan Arunachalam, Chitaru Kurihara

Published in

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs. Volume 29. Issue 3. Aug 17, 2026. Epub Aug 17, 2026.

Abstract

Venovenous extracorporeal membrane oxygenation (VV-ECMO) bridging to lung transplant has the potential to reduce mortality among patients awaiting transplant. However, there continue to be notable morbidity risks, including acute kidney injury (AKI). This paper seeks to evaluate both short and long-term morbidity and mortality trends related to AKI development post-transplant, among VV-ECMO bridged and non-ECMO bridged patients respectively. We performed a retrospective cohort study of adult patients (≥ 18 years) who underwent lung transplantation at a single tertiary care center between January 2018 and May 2024. 443 lung transplant recipients were included: 46 were bridged with preoperative VV-ECMO, and 397 underwent transplantation without ECMO bridge. Univariate logistic regression was used to evaluate predictors of postoperative AKI. A multivariable logistic regression model was then constructed using clinically relevant covariates and variables associated with AKI in univariate analyses. The initial incidence of post-operative AKI was significantly higher among patients bridged with VV-ECMO (67% vs. 44% P = 0.005), as were overall complications, including primary graft dysfunction grade 3 (41% vs. 9.8%, P < 0.001) and longer duration of mechanical ventilation (6.0 [2.0-17.0] vs. 2.0 [1.0-3.0] days, P < 0.001). However, there was no significant difference in renal function trajectories between VV-ECMO bridged and non-bridged groups from 1 month to 1 year, operationalized via GFR and creatinine trends. There was no statistically significant difference in survival between VV-ECMO bridged and non-bridged groups (P = 0.93). Independent of bridging status, patients who developed AKI post-operatively had significantly worse short and long-term survival after transplantation than those without AKI (log-rank P < 0.0001). Preoperative VV-ECMO bridging was not associated with a statistically significant difference in overall survival during the available follow-up. In contrast, postoperative AKI was independently associated with increased mortality after lung transplantation.

PMID:
42608603
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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