title: Urgent lung transplant programme in Italy: analysis of the first 14 months.
abstract: OBJECTIVE
  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.affiliation: Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy massimo.boffini@unito.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Boffini
authors.affiliation: Department of Thoracic Surgery, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Department of Thoracic Surgery, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Department of Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.affiliation: Department of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santambrogio
authors.affiliation: Department of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Andrea Maria
authors.initials: AM
authors.lastname: D'Armini
authors.affiliation: Department of Thoracic Surgery, IsMeTT-UPMC, University of Pittsburgh, Palermo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bertani
authors.affiliation: Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Voltolini
authors.affiliation: Department of Cardiac Surgery, Ospedale Bambin Gesù, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Parisi
authors.affiliation: Department of Cardiac Surgery, Ospedale Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
authors.affiliation: Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nanni Costa
authors.affiliation: Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D000328:Adult; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Extracorporeal lung support; Extracorporeal membrane; Lung transplantation; Mechanical ventilation; Oxygenation; Urgent lung transplantation