title: One-year experience with high-emergency lung transplantation in France.
abstract: BACKGROUND
  The continuing significant number of patients who die while on a waiting list for lung transplantation (LTx) has led several countries to modify their lung allocation rules in recent years. France has implemented high-emergency allocation rules to allow patients at imminent risk of death to undergo priority transplantation within several days. The aim of this study was to report on the early (2-year) experience of high-emergency LTx (HELTx) in France.
  
  
  METHODS
  From July 1, 2007, to June 30, 2008, 186 patients underwent LTx in France in nine centers. Among them, 32 patients (17.2%) underwent HELTx (19 with cystic fibrosis, 7 pulmonary fibrosis, and 6 other diagnoses). The reasons for HELTx were risk of invasive mechanical ventilation (n=20), invasive mechanical ventilation (n=8), and extracorporeal membrane oxygenation (n=4).
  
  
  RESULTS
  The median time between being placed on the HELTx waiting list and LTx was 3 days (interquartile range: 1-8 days). Survival rates in the HELTx group were 90.5%, 71%, 64.5%, 55%, and 51.5% at 1, 3, 6, 12, and 24 months, respectively, which were significantly lower than for 154 patients who underwent regular, nonurgent LTx during the study period (88.5%, 83%, 79%, 77%, and 71%, respectively).
  
  
  CONCLUSIONS
  Our data demonstrate that the new LTx allocation rules implemented in France since 2007 allow for rapid organ procurement for patients at imminent high risk of death. HELTx is feasible but yields poorer survival than elective LTx. Further studies are needed to assess implications of this organ allocation policy on the long run.
authors.affiliation: Service de chirurgie cardiaque, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Boussaud
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Isabelle
authors.initials: I
authors.lastname: Danner-Boucher
authors.forename: Claire
authors.initials: C
authors.lastname: Dromer
authors.forename: Christelle Saint
authors.initials: CS
authors.lastname: Raymond
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
authors.forename: Romain
authors.initials: R
authors.lastname: Kessler
authors.forename: François
authors.initials: F
authors.lastname: Philit
authors.forename: Richard
authors.initials: R
authors.lastname: Dorent
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
mesh_terms: D000293:Adolescent; D000328:Adult; D004630:Emergencies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D015996:Survival Rate