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Roussel A, Sage E, Falcoz PE, Thomas PA, Castier Y, Fadel E, Le Pimpec-Barthes F, Tronc F, Jougon J, Lacoste P, Claustre J, Brouchet L, Dorent R, Cantu E, Harhay M, Porcher R, Mordant P. Survival outcomes following urgent lung transplantation in France and the USA. Thorax 2024; 79:745-753. [PMID: 38768985 DOI: 10.1136/thorax-2023-220847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT). METHODS US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT performed between 2007 and 2017. We analysed the mortality risk of urgent LT by fitting Cox models and adjusted Restricted Mean Survival Time. We then compared the outcome after urgent LT in the UNOS and Cristal groups using a propensity score matching. RESULTS After exclusion of patients with chronic obstructive pulmonary disease/emphysema and redo LT, 3775 and 12 561 patients underwent urgent LT and non-urgent LT in the USA while 600 and 2071 patients underwent urgent LT and non-urgent LT in France. In univariate analysis, urgent LT was associated with an HR for death of 1.24 (95% CI 1.05 to 1.48) in the Cristal group and 1.12 (95% CI 1.05 to 1.19) in the UNOS group. In multivariate analysis, the effect of urgent LT was attenuated and no longer statistically significant in the Cristal database (HR 1.1 (95% CI 0.91 to 1.33)) while it remained constant and statistically significant in the UNOS database (HR 1.12 (95% CI 1.05 to 1.2)). Survival comparison of urgent LT patients between the two countries was significantly different in favour of the UNOS group (1-year survival rates 84.1% (80.9%-87.3%) vs 75.4% (71.8%-79.1%) and 3-year survival rates 66.3% (61.9%-71.1%) vs 62.7% (58.5%-67.1%), respectively). CONCLUSION Urgent LT is associated with adverse outcome in the USA and in France with a better prognosis in the US score-based system taking post-transplant survival into account. This difference between two healthcare systems is multifactorial.
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Affiliation(s)
- Arnaud Roussel
- Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hopital Foch, Suresnes, France
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery and Lung Transplantation, Strasbourg University Hospitals, Strasbourg, France
| | | | - Yves Castier
- Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France
| | - Elie Fadel
- University Paris, Saclay, France
- Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis, France
| | - Françoise Le Pimpec-Barthes
- Thoracic Surgery and Lung Transplantation, Hopital Europeen Georges Pompidou, Paris, France
- Universite Paris Descartes Faculte de Medecine, Paris, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Jacques Jougon
- Department of Thoracic Surgery and Lung Transplantation, CHU de Bordeaux, Bordeaux, France
| | - Philippe Lacoste
- Department of Thoracic Surgery and Lung Transplantation, Hopital Nord Laennec, Nantes, France
| | | | - Laurent Brouchet
- Thoracic Surgery Department, University Hospital CHU Toulouse, Toulouse, France
| | | | - Edward Cantu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Harhay
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raphaël Porcher
- Department of Biostatistics and Epidemiology, Inserm U1153, Paris, France
| | - Pierre Mordant
- Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France
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Courtwright AM, Whyte AM, Devarajan J, Fritz AV, Martin AK, Wilkey B, Stollings L, Cassara CM, Tawil JN, Miltiades AN, Bottiger BA, Pollak AL, Boisen ML, Harika RS, Street C, Terracciano W, Green J, Subramani S, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part I: Lung Transplantation. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00309-4. [PMID: 39256076 DOI: 10.1053/j.jvca.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 09/12/2024]
Abstract
These highlights focus on the research in lung transplantation (LTX) that was published in 2022 and includes the assessment and optimization of candidates for LTX, donor optimization, the use of organs from donation after circulatory death, and outcomes when using marginal or novel donors; recipient factors affecting LTX, including age, disease, the use of extracorporeal life support; and special situations, such as coronavirus disease2019, pediatric LTX, and retransplantation. The remainder of the article focuses on the perioperative management of LTX, including the perioperative risk factors for acute renal failure (acute kidney injury); the incidence and management of phrenic nerve injury, delirium, and pain; and the postoperative management of hyperammonemia, early postoperative infections, and the use of donor-derived cell-free DNA to detect rejection.
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Affiliation(s)
- Andrew M Courtwright
- Department of Clinical Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alice M Whyte
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, CO
| | - Lindsay Stollings
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Justin N Tawil
- Department of Anesthesiology, University of Wisconsin, WI
| | - Andrea N Miltiades
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Brandi A Bottiger
- Associate Professor, Department of Anesthesiology, Duke University, Durham, NC
| | - Angela L Pollak
- Associate Professor, Department of Anesthesiology, Duke University, Durham, NC
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ricky S Harika
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | - Christina Street
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | | | - Jeff Green
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
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Reed RD, Locke JE. Mitigating Health Disparities in Transplantation Requires Equity, Not Equality. Transplantation 2024; 108:100-114. [PMID: 38098158 PMCID: PMC10796154 DOI: 10.1097/tp.0000000000004630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Despite decades of research and evidence-based mitigation strategies, disparities in access to transplantation persist for all organ types and in all stages of the transplant process. Although some strategies have shown promise for alleviating disparities, others have fallen short of the equity goal by providing the same tools and resources to all rather than tailoring the tools and resources to one's circumstances. Innovative solutions that engage all stakeholders are needed to achieve equity regardless of race, sex, age, socioeconomic status, or geography. Mitigation of disparities is paramount to ensure fair and equitable access for those with end-stage disease and to preserve the trust of the public, upon whom we rely for their willingness to donate organs. In this overview, we present a summary of recent literature demonstrating persistent disparities by stage in the transplant process, along with policies and interventions that have been implemented to combat these disparities and hypotheses for why some strategies have been more effective than others. We conclude with future directions that have been proposed by experts in the field and how these suggested strategies may help us finally arrive at equity in transplantation.
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Affiliation(s)
- Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
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Hoetzenecker K, Vos R. The Ryder Cup of lung transplantation. J Heart Lung Transplant 2022; 41:1736-1737. [PMID: 36243642 DOI: 10.1016/j.healun.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- K Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
| | - R Vos
- Department of Respiratory Diseases, University Hospitals Leuven - Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Dept of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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