Lung transplantation for the treatment of irreversible acute respiratory distress syndrome

Abstract

Background: Despite advances in critical care for acute respiratory distress syndrome (ARDS), some survivors in the acute phase are unable to wean from extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. To date, little is known regarding whether lung transplantation confers a survival benefit for irreversible ARDS. Methods: This retrospective study was conducted using the United Network for Organ Sharing database (May 2005–December 2018). Patients with restrictive lung disease were divided into two groups: patients with and without ARDS. Propensity score matching identified recipients without ARDS for the control group. Results: A total of 63 patients with ARDS were waitlisted for lung transplantation, while 39 received a lung transplant after a median waitlist duration of 8 days. Seventy-eight patients were matched as controls. In the ARDS group, the median age was 30 years, and the median lung allocation score was 88.4. Among the 39 recipients, 30 (76.9%) received ECMO support prior to transplantation. Lung transplantation for ARDS and restrictive lung disease showed similar 90-day (87.2% vs. 88.5%, p =.80), 1-year (82.1% vs. 85.9%, p =.52), and 3-year (69.2% vs. 65.4%, p =.94) survival rates. Conclusions: Lung transplantation provides acceptable outcomes in selected patients with irreversible ARDS.