Venous thromboembolism (VTE) is a common complication following lung transplantation, and perioperative extracorporeal membrane oxygenation (ECMO) use has increased substantially over time. The relationship between ECMO exposure and early post-transplant VTE remains incompletely defined.

Is perioperative ECMO utilization associated with an increased risk of VTE within 14 days of lung transplantation?

A single center retrospective cohort study of adult lung transplants from 2010 to 2024 was performed. The primary outcome was the occurrence of a deep venous thrombosis (DVT) or pulmonary embolism (PE) within 14 days of transplant. Multivariable logistic regression was used to identify independent predictors of VTE during this time period and Cox proportional hazards models to evaluate the association between early VTE and survival.

Among the 1,083 lung transplant recipients, 22% developed VTE within 14 days. The incidence of VTE increased over time (11% in 2010–2013 vs 38% in 2022–2024, p < 0.001), paralleling the increase in ECMO utilization as well as implementation of a screening protocol. In adjusted analysis, both preoperative (adjusted OR 2.82, 95% CI 1.45–5.52) and intraoperative/postoperative ECMO exposures (adjusted OR 2.24, 95% CI 1.52–3.29) were independently associated with VTE. Early VTE was not associated with mortality (adjusted HR 0.87, 95% CI 0.67–1.12).

Early VTE after lung transplantation is common and has increased over time alongside increasing ECMO utilization. Perioperative ECMO exposure is independently associated with VTE. The findings highlight the need for targeted VTE prevention and surveillance strategies in lung transplant patients receiving ECMO support.