Following lung and heart-lung transplantation, pulmonary graft failure unresponsive to aggressive conventional therapy may be fatal. Fourteen transplant recipients were placed on extracorporeal membrane oxygenation (ECMO) for pulmonary graft dysfunction. Nine patients had early (≤ 24 hours) graft failure while 5 had late (> 7 days) failure. Seven (78%) patients in the early group were weaned off ECMO and 5 (56%) survived to hospital discharge. In the late group, none of the patients could be weaned off ECMO, yielding 100% mortality. ECMO support instituted for pulmonary graft failure that occurred within 24 hours of transplantation may improve patient survival. Copyright (C) 2000 International Society for Heart and Lung Transplantation.