Pneumologie · Oct 21, 2026
Age-related Long-Term Outcomes after ECMO Bridging to Lung Transplantation: A 15-Year Single-Center Experience
By Zelmer O, Abu Isneineh R, Seeliger B et al.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridging strategy to lung transplantation. Long-term outcomes in this specific patient population after lung transplantation remain incompletely described. We investigated age-dependent long-term outcomes in adult lung transplant candidates on waiting list while receiving ECMO support. METHODS: We performed a retrospective single-center cohort study including all adult patients listed for lung transplantation while receiving ECMO support between November 2010 and May 2025. Patients were stratified a priori by age at listing (<50 versus ≥50 years). The primary endpoint was 5-year post-transplant graft survival, defined as freedom from death or retransplantation. Secondary endpoints included comorbidities, frailty, exercise capacity, return to work, and patient-reported outcomes during outpatient follow-up. RESULTS: Among 1,493 patients listed for lung transplantation, 115 were listed while receiving ECMO support; 72 patients were aged <50 years and 43 patients were aged ≥50 years. Overall, 93 ECMO-listed patients (81%) underwent transplantation. One-, three-, and five-year post-transplant graft survival were 87%, 83%, and 77% in recipients aged <50 years compared with 72%, 53%, and 44% in recipients aged ≥50 years, respectively. Kaplan-Meier analysis demonstrated a significant difference between age groups. Recipient age ≥50 years was independently associated with an increased risk of graft loss in multivariable analysis (adjusted HR 2.53, 95% CI 1.14-5.59; p=0.022). Among patients reaching outpatient follow-up, older recipients had a slightly higher comorbidity burden, reduced exercise capacity, and lower rates of return to work, while Clinical Frailty Scale ≥4 remained relatively uncommon. CONCLUSIONS: In this 15-year single-center experience, recipient age ≥50 years was independently associated with inferior graft survival after ECMO-bridged lung transplantation. These findings support careful, function-oriented selection of older ECMO-supported candidates.