title: High Emergency Lung Transplantation: dramatic decrease of waiting list death rate without relevant higher post-transplant mortality.
abstract: Many candidates for lung transplantation (LT) die on the waiting list, raising the question of graft availability and strategy for organ allocation. We report the experience of the new organ allocation program, "High Emergency Lung Transplantation" (HELT), since its implementation in our center in 2007. Retrospective analysis of 201 lung transplant patients, of whom 37 received HELT from 1st July 2007 to 31th May 2012. HELT candidates had a higher impairment grade on respiratory status and higher Lung Allocation Score (LAS). HELT patients had increased incidence of perioperative complications (e.g., perioperative bleeding) and extracorporeal circulatory assistance (75% vs. 36.6%, P = 0.0005). No significant difference was observed between HELT and non-HELT patients in mechanical ventilation duration (15.5 days vs. 11 days, P = 0.27), intensive care unit length of stay (15 days vs. 10 days, P = 0.22) or survival rate at 12 (81% vs. 80%), and 24 months post-LT (72.9% vs. 75.0%). Lastly, mortality on the waiting list was spectacularly reduced from 19% to 2% when compared to the non-HELT 2004-2007 group. Despite a more severe clinical status of patients on the waiting list, HELT provided similar results to conventional LT. These results were associated with a dramatic reduction in the mortality rate of patients on the waiting list.
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.|UPRES EA220, Université de Versailles Saint-Quentin-en-Yvelines, Suresnes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roux
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Beaumont-Azuar
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Abdul Monem
authors.initials: AM
authors.lastname: Hamid
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: De Miranda
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grenet
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.|Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie et Soins Intensifs, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Briend
authors.affiliation: Thoracic Surgery Department, Foch Hospital, Suresnes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonnette
authors.affiliation: Thoracic Surgery Department, Foch Hospital, Suresnes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Puyo
authors.affiliation: Thoracic Intensive Care Unit, Foch Hospital, Suresnes, France.
authors.forename: François
authors.initials: F
authors.lastname: Parquin
authors.affiliation: Intensive Care Unit, Foch Hospital, Suresnes, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Devaquet
authors.affiliation: Intensive Care Unit, Foch Hospital, Suresnes, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Trebbia
authors.affiliation: Thoracic Intensive Care Unit, Foch Hospital, Suresnes, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Cuquemelle
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Douvry
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Picard
authors.affiliation: Anesthesiology Department, Foch Hospital, Suresnes, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Le Guen
authors.affiliation: Thoracic Surgery Department, Foch Hospital, Suresnes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Chapelier
authors.affiliation: Pneumology Department, Foch Hospital, Suresnes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
authors.affiliation: Thoracic Surgery Department, Foch Hospital, Suresnes, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Sage
mesh_terms: D000328:Adult; D003422:Critical Care; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: graft allocation; lung transplantation; mortality on waiting list