TY - JOUR
T1 - Outcomes and risk factors identification in urgent lung transplantation
T2 - A multicentric study
AU - Schiavon, Marco
AU - Faggi, Giulio
AU - Rosso, Lorenzo
AU - Luzzi, Luca
AU - Comacchio, Giovanni Maria
AU - Gregori, Dario
AU - Nosotti, Mario
AU - Damarco, Francesco
AU - Dell’Amore, Andrea
AU - Bennet, David
AU - Fossi, Antonella
AU - Paladini, Piero
AU - Santambrogio, Luigi
AU - Rea, Federico
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: ULT program allows transplantation in a significant percentage of patients with acceptable results. Pre-operative recipient selection is mandatory to improve clinical outcomes.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: ULT program allows transplantation in a significant percentage of patients with acceptable results. Pre-operative recipient selection is mandatory to improve clinical outcomes.
KW - C-reactive protein (CRP)
KW - Extracorporeal membrane oxygenation (ECMO)
KW - Lung allocation score
KW - Lung transplantation (LT)
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U2 - 10.21037/jtd.2019.10.55
DO - 10.21037/jtd.2019.10.55
M3 - Article
AN - SCOPUS:85077126373
VL - 11
SP - 4746
EP - 4754
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
SN - 2072-1439
IS - 11
ER -