Abstract
Introduction Since July 2007, the French High Emergency Lung Transplantation (HELT) allocation procedure prioritises available lung grafts to waiting patients with imminent risk of death. The relative impacts of donor, recipient, and matching on the outcome following HELT remain unknown.
We aimed at deciphering the relative impacts of donor, recipient, and matching on the outcome following HELT in an exhaustive administrative database.
Methods All lung transplantations (LT) performed in France were prospectively registered in an administrative database. We retrospectively reviewed the procedures performed between July 2007 and December 2015 and analysed the impact of donor, recipient, and matching on overall survival after the HELT procedure by fitting marginal Cox models.
Results During the study period, 2335 patients underwent LT in 11 French centers. After exclusion of patients with chronic obstructive pulmonary disease/emphysema, 1544 patients were included: 503 HELT and 1041 regular allocations. HELT was associated with a hazard ratio (HR) for death of 1.41 (95% confidence interval [CI], [1.22 to 1.64], p<0.0001) in univariate analysis, decreasing to 1.32 [1.10; 1.60] after inclusion of recipient characteristics in a multivariate model. A donor score computed to predict long term survival was significantly different between HELT and non-HELT groups (p=0.014). However, the addition of donor characteristics to recipient characteristics in the multivariate model did not change the HR associated with HELT.
Conclusion This exhaustive French national study suggests that High Emergency Lung Transplantation is associated with an adverse outcome as compared with regular allocation. This adverse outcome is mainly related to the severity of the recipients rather than donor or matching characteristics.
Footnotes
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Conflict of interest: Dr. Roussel has nothing to disclose.
Conflict of interest: Edouard Sage.
Conflict of interest: Dr. Massard has nothing to disclose.
Conflict of interest: Dr. THOMAS has nothing to disclose.
Conflict of interest: Dr. Castier has nothing to disclose.
Conflict of interest: Dr. Fadel has nothing to disclose.
Conflict of interest: Dr. Le Pimpec-Barthes has nothing to disclose.
Conflict of interest: Dr. Maury has nothing to disclose.
Conflict of interest: Dr. JOUGON has nothing to disclose.
Conflict of interest: Dr. Lacoste has nothing to disclose.
Conflict of interest: Dr. Claustre has nothing to disclose.
Conflict of interest: Dr. Dahan has nothing to disclose.
Conflict of interest: Dr. PIRVU has nothing to disclose.
Conflict of interest: Dr. Tissot has nothing to disclose.
Conflict of interest: Dr. Thumerel has nothing to disclose.
Conflict of interest: Dr. Drevet has nothing to disclose.
Conflict of interest: Dr. Pricopi has nothing to disclose.
Conflict of interest: Dr. Le Pavec has nothing to disclose.
Conflict of interest: Dr. Mal has nothing to disclose.
Conflict of interest: Dr. D'Journo has nothing to disclose.
Conflict of interest: Dr. KESSLER has nothing to disclose.
Conflict of interest: Dr. ROUX has nothing to disclose.
Conflict of interest: Dr. Dorent has nothing to disclose.
Conflict of interest: Dr. Thabut has nothing to disclose.
Conflict of interest: Dr. Mordant has nothing to disclose.
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