BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) for end-stage interstitial lung disease (ILD) and pulmonary hypertension (PH) has varying results based on ECMO configuration. We compare our experience using venovenous (VV) and venoarterial (VA) ECMO BTT for ILD with PH on survival to successful transplantation. METHODS: A single center retrospective review of patients with ILD and secondary PH who were placed on either VV or VA ECMO as BTT from 2010 to 2016. Comparisons for factors associated with survival to transplantation between VV and VA ECMO strategies were made using Cox proportional hazards model. Subgroup analysis included comparisons of VV ECMO patients who remained on VV or were converted to VA ECMO. RESULTS: A total of 50 patients with ILD and PH were treated initially with either VV (n=19) or VA (n=31) ECMO as BTT. Initial VA ECMO had a significantly higher survival to transplantation compared to initial VV ECMO (p=0.03). Cox proportional hazards modeling showed a 59% reduction in risk of death in VA compared to VV ECMO (HR: 0.41, 95%CI: 0.18-0.92, p=0.03). Patients converted from VV to VA ECMO had significantly longer survival awaiting transplant than those who remained on VV ECMO (p=0.03). Ambulation on ECMO prior to transplantation was associated with an 80% reduction in the risk of death (HR: 0.20, 95%CI: 0.08-0.48, p<0.01). CONCLUSIONS: VA ECMO upper body configuration for patients with end stage ILD and PH significantly improves overall survival to transplantation.