Lung Transplantation as Acute ‘Rescue’ Therapy

Abstract

<h3>Purpose</h3> Lung transplantation (LT) is an effective treatment of end-stage lung disease. Despite recommendations for optimal referral for LT, some patients still present in distress seeking emergent rescue LT. Traditionally, these patients have been considered too ill to benefit from LT. Clinical outcomes for this population remain uncertain. Here, we compare outcomes between emergently transplanted patients with standard LT recipients. <h3>Methods</h3> A retrospective review of all LT recipients at our center between January 1, 2015 and December 31, 2019 was performed. 204 patients underwent standard evaluation and ten patients were referred for and underwent rescue LT. The rescue cohort consisted of patients not previously known to the transplant team but were urgently evaluated and listed for LT, after presenting in respiratory distress (oxygen needs ≥ 60% FiO₂ or need for mechanical ventilation +/- ECMO support). <h3>Results</h3> Mean LAS at LT was 81.99 in the rescue group (RG) and 39.19 in the standard group (SG) (student's t test: p<0.0001). One year survival in the RG was 90% and 88.23% in the SG (Kaplan-Meier p=0.89). Median ICU length of stay (LOS) of the RG and SG were 14 and 5 days respectively (Mann-Whitney U test p=0.4). The median index LOS was 31 days in the RG and 19 days in the SG (Mann-Whitney U test p=0.50). The total number of hospital days in the first post-LT year was a median of 46.5 days in the RG and 40 in the SG (Mann-Whitney U test p=0.50). Of surviving recipients, 55.6% of RG and 14.1% of SG patients required dialysis (HD) at hospital discharge (χ ²=10.97; p=0.006). Of surviving recipients, 33.3% of the RG and 7.2% in the SG were receiving HD at one year (χ ²=7.54; p=0.03). 44.4% of the RG were discharged to home vs. 83.3% of the SG (χ ²=6.28; p=0.03). <h3>Conclusion</h3> Compared to patients referred in accordance with published guidelines, the RG experienced no worse 1 year post-LT survival but did have increased index ICU stays, HD needs, and need for post-hospitalization inpatient care. Given these observances, our results support continuing to offer LT as a rescue therapy.