title: Lung transplantation as rescue therapy in patients too sick to be discharged from acute care.
abstract: BACKGROUND
  There is an increasing demand for lung transplantation in patients in advanced respiratory failure. Although many of these patients do not require mechanical ventilation or extracorporeal membrane oxygenation, an increasing number are critically ill. In this single-center study, we have analyzed our experience with lung transplantation in subjects who were inpatients at the time of their transplant and not expected to survive to discharge.
  
  
  METHODS
  Between July 2006 and March 2012, we performed 274 bilateral sequential lung transplants and 34 single-lung transplants. Twenty-six patients who were inpatients at the time of their transplant, and were not expected to survive to hospital discharge, formed the inpatient group in this retrospective review. The remaining 281 outpatient lung transplant patients formed the comparison group.
  
  
  RESULTS
  The inpatient group spent significantly fewer days on the waiting list compared to the outpatient group. Postoperative survival was significantly poorer in the inpatient group compared to the outpatient group (P = .001), and this was most noticeable in the first 90 days. There was no significant difference in survival between the inpatient transplant cohort and a historically comparable wait list cohort (P = .614).
  
  
  CONCLUSIONS
  Lung transplantation in critically ill inpatients, although associated with a survival advantage compared to not transplanting them, does give poorer survival results compared to postoperative survival in outpatient patients.
authors: Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia.
authors: A
authors: A
authors: Doi
authors: Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia.
authors: G
authors: G
authors: Lee
authors: Lung Transplant Service, The Alfred Hospital, Melbourne, Australia.
authors: G
authors: G
authors: Snell
authors: Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia.
authors: M
authors: M
authors: Bloch
authors: Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia.
authors: R
authors: R
authors: Summerhayes
authors: Cardiothoracic Surgery Unit, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia. Electronic address: s.marasco@alfred.org.au.
authors: S
authors: S
authors: Marasco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010351:Patient Discharge; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult