Urgent lung transplant programme in Italy

analysis of the first 14 months

Massimo Boffini, Federico Venuta, Federico Rea, Michele Colledan, Luigi Santambrogio, Andrea M aria D'Armini, Alessandro Bertani, Luca Voltolini, Francesco Parisi, Giuseppe Marinelli, Alessandro Nanni Costa, Mauro Rinaldi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: Lung transplantation (LTx) is the only effective treatment for end-stage lung disease. In rapidly deteriorating patients awaiting transplant, supportive strategies for lung function allow only a short period of support and lung transplantation remains the definitive therapy. An urgent transplant programme may reduce the waiting time, allowing lung transplantation in these patients.

METHODS: Since November 2010 a nation-wide urgent lung transplant programme has been established in Italy and patients on the waiting list dependent on mechanical ventilation and/or extracorporeal lung support (ECLS) can be transplanted on an emergency basis with the first available graft in the country. Results of the first 14 months of this programme are analysed here.

RESULTS: From November 2010 to December 2011, 28 patients (14 males, mean age 33.6 ± 14.4 years) were considered for urgent LTx. Rapidly deteriorating lung function was supported with mechanical ventilation alone in 4 patients (14.3%), ECLS in 13 patients (46.4%) and mechanical ventilation plus ECLS in the remaining 11 patients (39.3%). Three patients (10.7%) were excluded because of worsening conditions, 3 patients (10.7%) while on the urgent listed and 22 patients (78.6%) underwent transplantation after 9.8 ± 6.2 days of being on the urgent list. The 30-day mortality rate after LTx was 18%, and the 1-year survival rate was 71.4%.

CONCLUSIONS: The urgent lung transplant programme allowed transplantation in a significant percentage of prioritized patients with acceptable 30-day and 1-year mortality rates. An accurate selection of recipients may further improve the clinical impact of this programme, reducing the ethical concerns about transplantation in high-risk patients.

Original languageEnglish
Pages (from-to)795-800
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume19
Issue number5
DOIs
Publication statusPublished - Nov 1 2014

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Italy
Transplants
Lung
Lung Transplantation
Artificial Respiration
Transplantation
Waiting Lists
Mortality
Lung Diseases
Emergencies
Survival Rate

Keywords

  • Extracorporeal lung support
  • Extracorporeal membrane
  • Lung transplantation
  • Mechanical ventilation
  • Oxygenation
  • Urgent lung transplantation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Urgent lung transplant programme in Italy : analysis of the first 14 months. / Boffini, Massimo; Venuta, Federico; Rea, Federico; Colledan, Michele; Santambrogio, Luigi; D'Armini, Andrea M aria; Bertani, Alessandro; Voltolini, Luca; Parisi, Francesco; Marinelli, Giuseppe; Nanni Costa, Alessandro; Rinaldi, Mauro.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 19, No. 5, 01.11.2014, p. 795-800.

Research output: Contribution to journalArticle

Boffini, Massimo ; Venuta, Federico ; Rea, Federico ; Colledan, Michele ; Santambrogio, Luigi ; D'Armini, Andrea M aria ; Bertani, Alessandro ; Voltolini, Luca ; Parisi, Francesco ; Marinelli, Giuseppe ; Nanni Costa, Alessandro ; Rinaldi, Mauro. / Urgent lung transplant programme in Italy : analysis of the first 14 months. In: Interactive Cardiovascular and Thoracic Surgery. 2014 ; Vol. 19, No. 5. pp. 795-800.
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abstract = "OBJECTIVES: Lung transplantation (LTx) is the only effective treatment for end-stage lung disease. In rapidly deteriorating patients awaiting transplant, supportive strategies for lung function allow only a short period of support and lung transplantation remains the definitive therapy. An urgent transplant programme may reduce the waiting time, allowing lung transplantation in these patients.METHODS: Since November 2010 a nation-wide urgent lung transplant programme has been established in Italy and patients on the waiting list dependent on mechanical ventilation and/or extracorporeal lung support (ECLS) can be transplanted on an emergency basis with the first available graft in the country. Results of the first 14 months of this programme are analysed here.RESULTS: From November 2010 to December 2011, 28 patients (14 males, mean age 33.6 ± 14.4 years) were considered for urgent LTx. Rapidly deteriorating lung function was supported with mechanical ventilation alone in 4 patients (14.3{\%}), ECLS in 13 patients (46.4{\%}) and mechanical ventilation plus ECLS in the remaining 11 patients (39.3{\%}). Three patients (10.7{\%}) were excluded because of worsening conditions, 3 patients (10.7{\%}) while on the urgent listed and 22 patients (78.6{\%}) underwent transplantation after 9.8 ± 6.2 days of being on the urgent list. The 30-day mortality rate after LTx was 18{\%}, and the 1-year survival rate was 71.4{\%}.CONCLUSIONS: The urgent lung transplant programme allowed transplantation in a significant percentage of prioritized patients with acceptable 30-day and 1-year mortality rates. An accurate selection of recipients may further improve the clinical impact of this programme, reducing the ethical concerns about transplantation in high-risk patients.",
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T2 - analysis of the first 14 months

AU - Boffini, Massimo

AU - Venuta, Federico

AU - Rea, Federico

AU - Colledan, Michele

AU - Santambrogio, Luigi

AU - D'Armini, Andrea M aria

AU - Bertani, Alessandro

AU - Voltolini, Luca

AU - Parisi, Francesco

AU - Marinelli, Giuseppe

AU - Nanni Costa, Alessandro

AU - Rinaldi, Mauro

PY - 2014/11/1

Y1 - 2014/11/1

N2 - OBJECTIVES: Lung transplantation (LTx) is the only effective treatment for end-stage lung disease. In rapidly deteriorating patients awaiting transplant, supportive strategies for lung function allow only a short period of support and lung transplantation remains the definitive therapy. An urgent transplant programme may reduce the waiting time, allowing lung transplantation in these patients.METHODS: Since November 2010 a nation-wide urgent lung transplant programme has been established in Italy and patients on the waiting list dependent on mechanical ventilation and/or extracorporeal lung support (ECLS) can be transplanted on an emergency basis with the first available graft in the country. Results of the first 14 months of this programme are analysed here.RESULTS: From November 2010 to December 2011, 28 patients (14 males, mean age 33.6 ± 14.4 years) were considered for urgent LTx. Rapidly deteriorating lung function was supported with mechanical ventilation alone in 4 patients (14.3%), ECLS in 13 patients (46.4%) and mechanical ventilation plus ECLS in the remaining 11 patients (39.3%). Three patients (10.7%) were excluded because of worsening conditions, 3 patients (10.7%) while on the urgent listed and 22 patients (78.6%) underwent transplantation after 9.8 ± 6.2 days of being on the urgent list. The 30-day mortality rate after LTx was 18%, and the 1-year survival rate was 71.4%.CONCLUSIONS: The urgent lung transplant programme allowed transplantation in a significant percentage of prioritized patients with acceptable 30-day and 1-year mortality rates. An accurate selection of recipients may further improve the clinical impact of this programme, reducing the ethical concerns about transplantation in high-risk patients.

AB - OBJECTIVES: Lung transplantation (LTx) is the only effective treatment for end-stage lung disease. In rapidly deteriorating patients awaiting transplant, supportive strategies for lung function allow only a short period of support and lung transplantation remains the definitive therapy. An urgent transplant programme may reduce the waiting time, allowing lung transplantation in these patients.METHODS: Since November 2010 a nation-wide urgent lung transplant programme has been established in Italy and patients on the waiting list dependent on mechanical ventilation and/or extracorporeal lung support (ECLS) can be transplanted on an emergency basis with the first available graft in the country. Results of the first 14 months of this programme are analysed here.RESULTS: From November 2010 to December 2011, 28 patients (14 males, mean age 33.6 ± 14.4 years) were considered for urgent LTx. Rapidly deteriorating lung function was supported with mechanical ventilation alone in 4 patients (14.3%), ECLS in 13 patients (46.4%) and mechanical ventilation plus ECLS in the remaining 11 patients (39.3%). Three patients (10.7%) were excluded because of worsening conditions, 3 patients (10.7%) while on the urgent listed and 22 patients (78.6%) underwent transplantation after 9.8 ± 6.2 days of being on the urgent list. The 30-day mortality rate after LTx was 18%, and the 1-year survival rate was 71.4%.CONCLUSIONS: The urgent lung transplant programme allowed transplantation in a significant percentage of prioritized patients with acceptable 30-day and 1-year mortality rates. An accurate selection of recipients may further improve the clinical impact of this programme, reducing the ethical concerns about transplantation in high-risk patients.

KW - Extracorporeal lung support

KW - Extracorporeal membrane

KW - Lung transplantation

KW - Mechanical ventilation

KW - Oxygenation

KW - Urgent lung transplantation

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