Outcomes and risk factors identification in urgent lung transplantation: A multicentric study
Articolo
Data di Pubblicazione:
2019
Citazione:
Outcomes and risk factors identification in urgent lung transplantation: A multicentric study / M. Schiavon, G. Faggi, L. Rosso, L. Luzzi, G.M. Comacchio, D. Gregori, M. Nosotti, F. Damarco, A. Dell'Amore, D. Bennet, A. Fossi, P. Paladini, L. Santambrogio, F. Rea. - In: JOURNAL OF THORACIC DISEASE. - ISSN 2072-1439. - 11:11(2019 Nov), pp. 4746-4754. [10.21037/jtd.2019.10.55]
Abstract:
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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
C-reactive protein (CRP); Extracorporeal membrane oxygenation (ECMO); Lung allocation score; Lung transplantation (LT)
Elenco autori:
M. Schiavon, G. Faggi, L. Rosso, L. Luzzi, G.M. Comacchio, D. Gregori, M. Nosotti, F. Damarco, A. Dell'Amore, D. Bennet, A. Fossi, P. Paladini, L. Santambrogio, F. Rea
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