Optimal time of lung transplantation (LTX) must be found for maximum individual benefit. In some cases patients are referred to the transplant centers, too late or present unexspected rapid deterioration. While at UNOS only waiting time is considered, at EUROTRANSPLANT selected candidates are transplanted with higher priority. In previous observations, overall survival of these recipients seems to be poor thus questioning the practice of higher urgency codes. We thererfore investigated outcome of patients receiving lungs at high priority in our institution. Between 9/93 and 9/97 we performed a total of 42 single-, double- or heart-lung transplantations of whom 13 patients received lungs on special urgency request (SUR). Indications for SUR were: failed pulmonary thrombendarterectomy, dependency on more than 10 1/min oxygen, mechanical ventilation, progressive right heart failure, haemoptysis, severe pulmonary bleeding and adult respiratory distress syndrome, with two patients requiring extracorporal membran oxygenation. Patients receiving SUR were of younger age compared to patients with elective code (mean 25 vs. 46 years) and received primary transplantation surgery. The mean waiting time was 373 days for elective and 25 days for SUR recipients. Survival after transplantation on SUR vs. recipients on an elective code was 100% vs. 88% (3 months), 100% vs. 79% (6 months), 92% vs. 75% (1 year) and 63% vs. 46% (3 year survival). No patient died because of primary graft failure. One single SUR recipient developed invasive aspergillosis and died 339 days after transplantation. Our data demonstrate, that selected patients (young, first transplantion) with the need of a very urgent transplantation will have equal or better early and long-term survival than elective procedures.
Full conference title:
The American Lung Association - American Thoracic Association Conference,1998