Peetermans, Marijke and Bohyn, Alexandre and Meersseman, Philippe and Wilmer, Alexander and Wauters, Joost and Meyns, Bart and Lubnow, Matthias and Belmans, Ann and Mueller, Thomas and Vlaar, Alexander P. J. and Combes, Alain and Hermans, Greet (2025) Outcomes of transplant recipients on ECMO for COVID-19 respiratory failure: an ELSO registry study. CRITICAL CARE, 29 (1): 404. ISSN 1364-8535, 1466-609X
Full text not available from this repository. (Request a copy)Abstract
Background ECMO outcomes in COVID-19-related respiratory failure among solid organ transplant (SOT) and hematopoietic stem-cell transplant recipients (HSCT) are poorly described. We investigated: (1) whether transplant patients (SOT/HSCT) with COVID-19 have worse outcomes than non-immunocompromised (IC) COVID-19 patients, and (2) whether among transplant recipients (SOT/HSCT), those with COVID-19 have worse outcomes than those with non-COVID-19-related respiratory failure. Additionally, we aimed to identify factors independently associated with mortality among COVID-19 transplants. Methods Retrospective analyses of the Extracorporeal Life Support Organization Registry from 1/1/2017 to 31/07/2023. Two comparisons were made: (1) transplant COVID-19 versus non-IC COVID-19, and (2) transplant COVID-19 versus transplant non-COVID-19 patients. Outcomes were analyzed using propensity score (PS)-adjusted, multivariable, and PS-matched analyses, adjusting for a priori identified confounders. Primary outcome was in-hospital mortality. Results Among 38,270 runs, 146 transplant COVID-19, 12,552 non-IC-COVID-19 and 886 transplant non-COVID-19 runs were identified. In-hospital mortality in transplant COVID-19 patients was 75.3% and the risk was invariably increased compared to non-IC-COVID-19 (PS-adjusted OR: 2.36 [95%CI:1.61-3.46], p < 0.001, multivariable OR:2.35 [95%CI:1.59-3.49], p < 0.001, and PS-matched analysis OR: 1.89 [95%CI:1.21-2.95], p < 0.005) and transplant non-COVID-19 patients (PS-adjusted OR: 4.20 [95%CI:2.74-6.44], p < 0.001, multivariable OR: 3.79 [95%CI:2.51-5.74], p < 0.001, and PS-matched analyses OR: 3.17 [95%CI:1.90-5.28], p < 0.001). Mortality difference remained stable over time. Older age independently associated with higher mortality. This was accompanied by higher need for renal replacement therapy compared to non-IC-COVID-19 patients. Compared to transplant non-COVID-19 patients, ECMO runs and time-to-live discharge were invariably prolonged. Hemorrhagic, metabolic, pulmonary and infectious complications consistently occurred more frequently. Conclusions Mortality was high in COVID-19 transplant ECMO patients, warranting cautious use of ECMO in this population.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | EXTRACORPOREAL MEMBRANE-OXYGENATION; IMMUNOCOMPROMISED PATIENTS; SUPPORT; GUIDELINES; SURVIVAL; COHORT; CELL; Extracorporeal membrane oxygenation; Respiratory failure; COVID-19; Transplant |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 31 Mar 2026 10:08 |
| Last Modified: | 31 Mar 2026 10:08 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67831 |
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