title: High-emergency waiting list for lung transplantation: early results of a nation-based study.
abstract: OBJECTIVE
  The high mortality rate observed on the regular waiting list (RWL) before lung transplantation (LTx) prompted the French organ transplantation authorities to set up in 2007 a dedicated graft allocation strategy, the so-called 'high-emergency waiting list' (HEWL), for patients with an abrupt worsening of their respiratory function. This study reports on the early results of this new allocation system.
  
  
  METHODS
  Among 11 active French LTx programmes, 7 were able to provide full outcome data by 31 December 2011. The medical records of 101 patients who were listed on the HEWL from July 2007 to December 2011 were reviewed for an intention-to-treat analysis.
  
  
  RESULTS
  Ninety-five patients received LTx within a median waiting time on the HEWL of 4 days (range 1-26), and 6 died before transplantation. Conditions were cystic fibrosis (65.2%), pulmonary fibrosis (24.8%), emphysema (5%) and miscellaneous (5%). The median age of the recipient was 30 years (range 16-66). Patients listed on the HEWL came from the RWL in 48.5% of the cases and were new patients in 51.5%. Forty-nine were placed under invasive ventilation and, in 26 cases, extracorporeal membrane oxygenation (ECMO) prior to transplantation was necessary as a complementary treatment. ECMO for non-intubated patients was performed in 6 cases. Eighty-one bilateral and 14 single LTx were performed, with an overall in-hospital mortality rate of 29.4%. One- and 3-year survival rates were 67.5 and 59%, respectively. Multivariate analysis shows that the use of ECMO prior to transplantation was the sole independent mortality risk factor (hazard ratio = 2.77 [95% CI 1.26-6.11]).
  
  
  CONCLUSIONS
  The new allocation system aimed at lowering mortality on the RWL, but also offered an access to LTx for new patients with end-stage respiratory failure. The HEWL increased the likelihood of mortality after LTx, but permitted acceptable mid-term survival rates. The high mortality associated with the use of ECMO should be interpreted cautiously.
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Orsini
authors.affiliation: Department of Thoracic Surgery, Hôpital Foch, Suresnes, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Sage
authors.affiliation: Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Olland
authors.affiliation: Department of Thoracic and Vascular Surgery, Hôpital Michallon, Grenoble, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cochet
authors.affiliation: Department of Thoracic Surgery, Hôpital Louis Pradel, Lyon, France.
authors.forename: Mayeul
authors.initials: M
authors.lastname: Tabutin
authors.affiliation: Department of Thoracic Surgery, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Thumerel
authors.affiliation: Department of Thoracic Surgery, Hôpital Larrey, Toulouse, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Charot
authors.affiliation: Department of Thoracic Surgery, Hôpital Foch, Suresnes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Chapelier
authors.affiliation: Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Department of Thoracic and Vascular Surgery, Hôpital Michallon, Grenoble, France.
authors.forename: Pierre Yves
authors.initials: PY
authors.lastname: Brichon
authors.affiliation: Department of Thoracic Surgery, Hôpital Louis Pradel, Lyon, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Tronc
authors.affiliation: Department of Thoracic Surgery, Hôpital Haut-Lévêque, Bordeaux, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Jougon
authors.affiliation: Department of Thoracic Surgery, Hôpital Larrey, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France.
authors.forename: Xavier Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.affiliation: Lung Transplantation Group, Hôpital Nord, Aix Marseille University, Marseille, France pathomas@ap-hm.fr pascal-alexandre.thomas@mail.ap-hm.fr.
authors.forename: Pascal Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: High emergency; Lung transplantation; Respiratory support