Outcomes and risk factors identification in urgent lung transplantation: a multicentric study

In rapidly lung deteriorating patients, urgent lung transplantation (ULT) seems the only definitive therapy. Few publications on this topic report conflicting results, putting a word of caution about ULT programs. A national ULT program was introduced in 2010: patients on mechanical support may be t...

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Veröffentlicht in:Journal of thoracic disease 2019-11, Vol.11 (11), p.4746-4754
Hauptverfasser: Schiavon, Marco, Faggi, Giulio, Rosso, Lorenzo, Luzzi, Luca, Comacchio, Giovanni Maria, Gregori, Dario, Nosotti, Mario, Damarco, Francesco, Dell'Amore, Andrea, Bennet, David, Fossi, Antonella, Paladini, Piero, Santambrogio, Luigi, Rea, Federico
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Sprache:eng
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Zusammenfassung:In rapidly lung deteriorating patients, urgent lung transplantation (ULT) seems the only definitive therapy. Few publications on this topic report conflicting results, putting a word of caution about ULT programs. A national ULT program was introduced in 2010: patients on mechanical support may be transplanted with the first available graft. We reviewed the experience of three national center, focusing on post-operative outcomes after ULT. Ten patients (17.5%) died awaiting transplantation, while 47 underwent LT with a median urgent waiting list time of 6 days. Pre-operatively, 4.3% of patients were supported only by mechanical ventilation (MV), 55.3% by extracorporeal membrane oxygenation (ECMO) and the remaining 40.4% by both. The main indication was cystic fibrosis (64%). Median recipient lung allocation score was 72. In-hospital mortality was 19%. MV and ECMO median duration of 7 and 3 days, respectively while intensive care unit (ICU) and hospital stay were 20 and 46 days, respectively. At long-term, 1- and 3-year survival rate were 74% and 70%, respectively. Highly impact risk factors for in-hospital mortality were both presence and duration of preoperative veno-arterial ECMO and pre-transplant C-reactive protein level. ULT program allows transplantation in a significant percentage of patients with acceptable results. Pre-operative recipient selection is mandatory to improve clinical outcomes.
ISSN:2072-1439
2077-6624
DOI:10.21037/jtd.2019.10.55