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Rare indications for a lung transplant. A European Society of Thoracic Surgeons survey

2020; Oxford University Press; Volume: 31; Issue: 5 Linguagem: Inglês

10.1093/icvts/ivaa165

1569-9293

Mario Nosotti, F. D’Ovidio, Miguel M. Leiva‐Juárez, Shaf Keshavjee, Mindaugas Račkauskas, Dirk Van Raemdonck, Laurens J. Ceulemans, Thorsten Krueger, Angela Koutsokera, Marco Schiavon, Federico Rea, İlker İskender, Paula Moreno, Antonio Álvarez, Luca Luzzi, Piero Paladini, Lorenzo Rosso, Alessandro Bertani, Federico Venuta, Ylenia Pecoraro, Khaled Alkattan, Bartosz Kubisa, İlhan İnci,

Mechanical Circulatory Support Devices

The European Society of Thoracic Surgeons Lung Transplantation Working Group promoted a survey to evaluate overall survival in a large cohort of patients receiving lung transplants for rare pulmonary diseases.We conducted a retrospective multicentre study. The primary end point was overall survival; secondary end points were survival of patients with the most common diagnoses in the context of rare pulmonary diseases and chronic lung allograft dysfunction (CLAD)-free survival. Finally, we analysed risk factors for overall survival and CLAD-free survival.Clinical records of 674 patients were extracted and collected from 13 lung transplant centres; diagnoses included 46 rare pulmonary diseases. Patients were followed for a median of 3.1 years. The median survival after a lung transplant was 8.5 years. The median CLAD-free survival was 8 years. The multivariable analysis for mortality identified CLAD as a strong negative predictor [hazard ratio (HR) 6.73)], whereas induction therapy was a protective factor (HR 0.68). The multivariable analysis for CLAD occurrence identified induction therapy as a protective factor (HR 0.51). When we stratified patients by CLAD occurrence in a Kaplan-Meier plot, the survival curves diverged significantly (log-rank test: P < 0.001). Patients with rare diseases who received transplants had chronic rejection rates similar to those of the general population who received transplants.We observed that overall survival and CLAD-free survival were excellent. We support the practice of allocating lungs to patients with rare pulmonary diseases because a lung transplant is both effective and ethically acceptable.