Association Between Listing Status Prior to Bridge Initiation and Lung Transplant Outcomes: A Nationwide Cohort Study.

Abstract

This study evaluated the association between transplant listing status prior to the initiation of extracorporeal membrane oxygenation (ECMO) or mechanical ventilation and posttransplant survival outcomes. We retrospectively analyzed data from the Korea Network for Organ Sharing registry (2014-2023). Patients not listed at the time of ECMO or mechanical ventilation initiation were classified as the unlisted bridging group, whereas those who required ECMO or mechanical ventilation after listing due to clinical deterioration were classified as the listed bridging group. Patients who underwent transplantation without ECMO or mechanical ventilation support were categorized as the non-bridge to transplantation (BTT) group. One-year mortality was assessed using Cox regression and log-rank analyses. Among 1056 lung transplant recipients, 347 were listed BTT, 283 were unlisted BTT, and 426 were non-BTT. One-year survival rates were 77.2% for listed BTT, 59.4% for unlisted BTT, and 79.8% for non-BTT (P < .001). In multivariable Cox regression, unlisted BTT was independently associated with higher mortality (hazard ratio, 2.20). Survival for listed BTT was comparable to non-BTT, whereas unlisted BTT had significantly worse outcomes (P < .001). In subgroup analysis by device type, listed ECMO BTT demonstrated survival similar to non-BTT, whereas listed mechanical ventilation BTT, listed ECMO + mechanical ventilation, unlisted mechanical ventilation, unlisted ECMO, and unlisted ECMO + mechanical ventilation were all associated with poorer 1-year survival. Being listed prior to bridging was associated with survival outcomes comparable to non-BTT recipients. In contrast, unlisted bridging status was associated with significantly poorer 1-year survival.