Outcomes of venovenous-extracorporeal membrane oxygenation bridging in lung transplant recipients with panel reactive antibody positivity.

BACKGROUND: Lung transplantation improves survival in advanced lung disease, but calculated Panel Reactive Antibody (cPRA) positive patients are at higher risk for adverse outcomes. It is unclear if sensitization poses additional risks in patients bridged to transplantation with venovenous extracorporeal membrane oxygenation (VV-ECMO). This study compares outcomes between cPRA-positive and -negative patients bridged with VV-ECMO. METHODS: Among 411 transplant recipients from an institutional lung transplantation database (January 2018-March 2025), 52 patients were bridged with VV-ECMO. Of these, 14 were cPRA-positive and 38 were cPRA-negative. Univariate and multivariate analyses evaluated early post-transplant complications and survival outcomes in cPRA-positive and -negative groups. RESULTS: Rates of post-transplant complications such as primary graft dysfunction (PGD) in any grade (85.7% cPRA-positive vs. 76.4% cPRA-negative, p = 0.48), PGD grade 3 (35.7% vs. 50.0%, p = 0.53), acute kidney injury (AKI) (64.3% vs. 68.4%, p = 1.00), dialysis requirement (21.4% vs. 34.2%, p = 0.51), deep vein thrombosis (DVT) (71.4% vs. 55.3%, p = 0.35), and pulmonary embolism (PE) (7.1% vs. 18.4%, p = 0.42) were similar. 1-year survival rate (85.1% vs. 82.9%) and overall survival (p = 0.81) were not significantly different. CONCLUSIONS: Post-transplant outcomes and survival were similar between cPRA-positive and -negative groups, suggesting that PRA status in VV-ECMO bridged lung transplant recipients is not associated with worse outcomes. VV-ECMO may remain a viable bridge to lung transplantation, even in sensitized patients.