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

Tuesday, March 24, 2026

12:30 PM - 1:30 PM Central Time

Location: Connections Central - RST 14

KQ

Katherine Quiza, MD

Mayo Clinic Hospital in Florida

Disclosure(s): No relevant financial relationship(s) to disclose.
AC

Ashutosh Chaudhary, MBBS

MBBS
Mayo Clinic Florida

Disclosure information not submitted.
PB

Prasanth Balasubramanian, MD

Transplant Pulmonologist
Mayo Clinic Hospital in Florida

Disclosure information not submitted.
RB

Remzi Bag, MD

Transplant Pulmonologist
Mayo Clinic Hospital in Florida

Disclosure information not submitted.
PG

Pramod Guru, MD

Consultant, Critical Care Medicine
Mayo Clinic Hospital in Florida

Disclosure information not submitted.
AC

Ashlesha Chaudhary, MBBS

Resident
Bassett Medical Center, Cooperstown, NY

Disclosure information not submitted.
SB

Suzit Bhusal, MBBS

Resident
Prime South GME Consortium, Harlingen Medical Center, Harlingen, TX

Disclosure information not submitted.
BW

Brad A. White, MD

Transplant Pulmonologist
Mayo Clinic Hospital, Rochester, MN

Disclosure information not submitted.
SC

Sanjay Chaudhary, MD

Consultant, Critical Care Medicine
Mayo Clinic Hospital in Florida

Disclosure information not submitted.

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.