Extracorporeal membrane oxygenation in the immediate post-liver transplantation setting: A national inpatient sample analysis

Introduction: There has been limited generalizable assessment of the utilization and outcomes of ECMO in the post-liver transplantation setting. Methods: This is a retrospective study using the National Inpatient Sample to assess liver transplantation hospitalizations from 2016 to 2021. Patients who were treated with ECMO were compared to those not treated with ECMO. Furthermore, outcomes when ECMO was initiated on the same day of transplantation were compared to outcomes when ECMO was initiated later. In-hospital mortality, renal replacement therapy (RRT), tracheostomy, discharge to home, length of stay and cost were the assessed outcomes. Results: 45,420 patients were included, 665 (1.5%) of which were treated with ECMO. Mean age of the combined cohort was 55.1 years and 63.1% of patients were male. Mortality was increased in those treated with ECMO (24.1% vs 2.7%, aOR = 11.20, 95% CI: 6.33–19.79, p < .001), as were rates of RRT (31.6% vs 16.5%, p < .001) and tracheostomy (10.5% vs 3.1%, p < .001). Mortality was increased when ECMO was initiated at least one calendar day after transplantation compared to same day cannulation (53.6% vs 16.2%, aOR = 3.52, 95% CI: 1.06–11.68, p = .039). Conclusions: Three-quarters of patients who undergo ECMO after liver transplantation survive to discharge and outcomes appear better in those who are cannulated on the same day of transplantation compared to those cannulated at least 1 day after transplantation.