BACKGROUND: Lung transplantation (LTx) is the definitive treatment for end-stage pulmonary diseases, with venoarterial extracorporeal membrane oxygenation (VA-ECMO) used as a common perioperative support. However, it remains unclear if central (cVA-ECMO) or peripheral (pVA-ECMO) cannulation routes yield better outcomes in postoperative prognosis. This study compares the impact of these two cannulation strategies on primary graft dysfunction (PGD) incidence in LTx patients. METHODS: A retrospective analysis was performed on 153 LTx patients supported with VA-ECMO at the Wuxi Lung Transplant Center (January 2019-March 2023). Patients were divided into central ( RESULTS: PGD incidence was significantly higher in the peripheral group, with longer ECMO duration, ventilation, and ICU stay. Central VA-ECMO showed advantages in in-hospital mortality and 1-year survival rates. CONCLUSION: Central VA-ECMO cannulation may reduce postoperative complications and improve survival for LTx recipients. Prospective studies are needed to confirm these findings and refine perioperative ECMO management.