(1708) Predictors of Lung Transplantation in COVID-19 Patients on Extracorporeal Membrane Oxygenation

Introduction: The COVID-19 pandemic has significantly impacted global health, with a subset of patients developing severe respiratory failure requiring extracorporeal membrane oxygenation (ECMO) and potentially lung transplantation as definitive management. There is currently limited data on predictors of lung transplantation in patients on ECMO due to COVID-19 respiratory failure. We aimed to identify clinical predictors of the need for lung transplantation to inform future clinical management.

Methods: This was a retrospective cohort study of critically ill COVID-19 patients with respiratory failure receiving ECMO at the University of Florida to identify demographic and clinical factors associated with lung transplantation. The primary outcome variable was lung transplantation. Variables were examined across groups using median values and proportions. Variable importance in relation to outcomes was measured using multivariable logistic regression. Candidate variables were assessed for multicollinearity. Results were reported using effect sizes, 95% confidence-intervals, and p-values.

Results: Data from 69 critically ill COVID-19 patients were analyzed (34 no transplant, 35 received lung transplant). Transplanted patients were more often male (77% vs 50%, p = 0.019), had lower BMIs (median 26 vs. 32, p< 0.001), had a higher prevalence of CKD (40% vs 18%, p = 0.041), and had longer ICU LOS (66 vs 32 days, p < 0.001) and total ECMO days (60 vs 24, p < 0.001). Transplanted patients more frequently had peak ECMO right ventricular (RV) dysfunction compared to non-transplanted patients (p=0.003). Transplanted patients had higher survival 30 days post ECMO decannulation (100% vs 50%, p < 0,001) and higher rates of survival to discharge (100% vs 50%, p < 0.001). Significant independent predictors of lung transplantation after COVID-19 were male gender (OR 15.7, CI 1.89-242, p = 0.02), peak ECMO BNP value (OR 1.0, CI 1.0-1.0, p = 0.029), peak ECMO RV dysfunction (mild, OR 19.8, 2.86-247, p = 0.007), and total ECMO days (1.02, 1.01-1.05, p = 0.023).

Conclusions: In this study, COVID-19 patients receiving lung transplantation had higher rates of survival to discharge. Independent predictors of lung transplantation included male gender, indicators of RV dysfunction (BNP or RV dysfunction), and total ECMO days.