Single‐center experience in urgent lung transplantation program in a country with a shortage of donors: Does the end justify the means?

Abstract

In rapidly deteriorating patients awaiting lung transplantation (LT), supportive strategies are only temporary and urgent lung transplant (ULT) remains the last option. The few publications on this topic report conflicting results. According to the Italian national program, patients on mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) may be included in urgent list. We reviewed our experience from January 2012 to December 2014 with ULT and elective lung transplantation (ELT), focusing on outcomes. In the study period, 16 patients received ULT, while 51 received ELT. Among ULT, 1 patient (5.8%) died in waiting list (WL) while 16 patients underwent LT with a median WL time of 6 days. ELT WL mortality was 13.5%, and median WL time 368 days. In-hospital mortality was lower in ELT group (5.8% vs 37.5%, P < .01), while the other postoperative outcomes were not significantly different. For ULT patients, the highest impact risk factors for in-hospital mortality were pretransplant plasma transfusion, recipient Pseudomonas aeruginosa colonization, and high level of reactive C-protein and lactic acid. A ULT program with an accurate recipient selection allows earlier transplantation, reducing WL mortality, with acceptable outcomes, although with a higher in-hospital mortality. Larger studies are needed to validate our results.

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

“…The two goals to consider when approaching ULT are the reduction of WL time and mortality assuring at the same time a postoperative survival comparable to elective procedures. Indeed, we recently demonstrated that the application of ULT in a singlecentre experience, despite a worse postoperative mortality compared to national results, confirmed the first goal of the program; in addition, previous unrecognized preoperative recipient risk factors for early fatal outcome were identified (5). Both these studies presented a weakness point in the number of patients involved and the short period analysed especially in the first one.…”

“…We previously investigated how the national priority allocation program worked in Padua Hospital, with encouraging results concerning the access to transplantation and mid-term outcomes (5).…”

The Surplus Transplant Lung Allocation System in Italy: An Evaluation of the Allocation Process via Stochastic Modeling

“…This is in line with what has been found in the research literature. Italy has a national opposed donor rate that exceeds 30% and there is a discrepancy between the northern and southern regions in terms of the number of organs donated [ 24 , 29 ]. In the future, the re-defining of the protocol could be considered with other concepts of fairness and equity, such as the centers’ transplant volume or waitlist length.…”

Anesthetic management in lung transplantation: Our single-center experience

“…The rate of ECMO use in LTx operations was reported to be 27.4 to 45% in previous studies. [24][25][26] The high rate of ECMO use in our series can be attributed to the high number of marginal donors due to the low number of donors and the high number of high-risk patients on our waiting list.…”

“…This results in a need to use marginal donor organs, thus increasing postoperative mortality. [24] The rate of one-year mortality after LTx is reported to be 17 to 50%. [30,31] The oneyear mortality rate in the present study was 17%.…”