Massimo Boffini1, Federico Venuta2, Federico Rea3, Michele Colledan4, Luigi Santambrogio5, Andrea Maria D'Armini6, Alessandro Bertani7, Luca Voltolini8, Francesco Parisi9, Giuseppe Marinelli10, Alessandro Nanni Costa11, Mauro Rinaldi12. 1. Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy massimo.boffini@unito.it. 2. Department of Thoracic Surgery, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy. 3. Department of Thoracic Surgery, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy. 4. Department of Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy. 5. Department of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 6. Department of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. 7. Department of Thoracic Surgery, IsMeTT-UPMC, University of Pittsburgh, Palermo, Italy. 8. Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 9. Department of Cardiac Surgery, Ospedale Bambin Gesù, Rome, Italy. 10. Department of Cardiac Surgery, Ospedale Sant'Orsola Malpighi, University of Bologna, Bologna, Italy. 11. Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy. 12. Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
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.
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.
Authors: C Petrini; D Peritore; L Riva; G Floridia; S Gainotti; P A Grossi; A G Castiglione; M Beretta; F Rea; M Nosotti; L Lombardini; M Cardillo Journal: Transplant Proc Date: 2022-06-01 Impact factor: 1.014
Authors: Marco Schiavon; Giulio Faggi; Lorenzo Rosso; Luca Luzzi; Giovanni Maria Comacchio; Dario Gregori; Mario Nosotti; Francesco Damarco; Andrea Dell'Amore; David Bennet; Antonella Fossi; Piero Paladini; Luigi Santambrogio; Federico Rea Journal: J Thorac Dis Date: 2019-11 Impact factor: 2.895