Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant

Recent lessons learned in the management of acute exacerbation of idiopathic pulmonary fibrosis

“…In selected patients with AE-IPF who fulfil the criteria for LTx, mechanical ventilation alone or in combination with extracorporeal membrane oxygenation (ECMO) may be appropriate as a bridge to LTx [89,90]. Although this is associated with a worse prognosis than LTx without a bridge [91][92][93], it can provide a survival chance for patients who would probably have died otherwise [93,94]. In addition, recent strategies of ambulatory ECMO or awake and non-intubated ECMO as a bridge to LTx have shown encouraging results [95][96][97].…”

Pulmonary hypertension as a risk factor of mortality after lung transplantation

“…The importance of PH for selected diseases leading to transplant indication is reflected within lung allocation systems, which prioritize patients based on urgency of transplantation and post-transplant outcome, such as UNOS (United Network for Organ Sharing [North America]), Eurotransplant, and HELT (High Emergency in Lung Transplantation [France]) (5,18,19). The importance of post-capillary PH (mPAP ≥ 25 mmHg, PAWP > 15 mmHg) diagnosed before transplantation is not fully elucidated, especially when considering posttransplantation outcomes.…”

Outcome of critically ill lung transplant candidates on invasive respiratory support

“…In a recent analysis, Smits et al [24] demonstrated that, overall, the LAS accurately predicted mortality in a cohort of candidates in Eurotransplant with HU status. In this published study, which included 317 patients (median LAS 35), 18 % were ventilated and 7 % were on ECS.…”

“…In this published study, which included 317 patients (median LAS 35), 18 % were ventilated and 7 % were on ECS. An adjustment of the original LAS may, however, be indicated according to Smits et al [24] in order to accurately predict wait list mortality in the sickest patients. A major problem is that the LAS does not include ECMO.…”