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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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Messika J, Eloy P, Boulate D, Charvet A, Fessler J, Jougon J, Lacoste P, Mercier O, Portran P, Roze H, Sage E, Thes J, Tronc F, Vourc'h M, Montravers P, Castier Y, Mal H, Mordant P. Protocol for venoarterial ExtraCorporeal Membrane Oxygenation to reduce morbidity and mortality following bilateral lung TransPlantation: the ECMOToP randomised controlled trial. BMJ Open 2024; 14:e077770. [PMID: 38448059 PMCID: PMC10916175 DOI: 10.1136/bmjopen-2023-077770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Lung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite no precise guidelines for its initiation. We aim to evaluate two strategies of VA-ECMO initiation in the perioperative period in patients with obstructive or restrictive lung disease requiring bilateral LTx. In the control 'on-demand' arm, high haemodynamic and respiratory needs will dictate VA-ECMO initiation; in the experimental 'systematic' arm, VA-ECMO will be pre-emptively initiated. We hypothesise a 'systematic' strategy will increase the number of ventilatory-free days at day 28. METHODS AND ANALYSIS We designed a multicentre randomised controlled trial in parallel groups. Adult patients with obstructive or restrictive lung disease requiring bilateral LTx, without a formal indication for pre-emptive VA-ECMO before LTx, will be included. Patients with preoperative pulmonary hypertension with haemodynamic collapse, ECMO as a bridge to transplantation, severe hypoxaemia or hypercarbia will be secondarily excluded. In the systematic group, VA-ECMO will be systematically implanted before the first pulmonary artery cross-clamp. In the on-demand group, VA-ECMO will be implanted intraoperatively if haemodynamic or respiratory indices meet preplanned criteria. Non-inclusion, secondary exclusion and VA-ECMO initiation criteria were validated by a Delphi process among investigators. Postoperative weaning of ECMO and mechanical ventilation will be managed according to best practice guidelines. The number of ventilator-free days at 28 days (primary endpoint) will be compared between the two groups in the intention-to-treat population. Secondary endpoints encompass organ failure occurrence, day 28, day 90 and year 1 vital status, and adverse events. ETHICS AND DISSEMINATION The sponsor is the Assistance Publique-Hôpitaux de Paris. The ECMOToP protocol version 2.1 was approved by Comité de Protection des Personnes Ile de France VIII. Results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT05664204.
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Affiliation(s)
- Jonathan Messika
- Service de Pneumologie B et Transplantation Pulmonaire, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Paris Transplant Group, Paris, France
| | - Philippine Eloy
- Département d'épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, Hôpital Bichat Claude-Bernard, Paris, France
- INSERM CIC-EC1425, Hôpital Bichat, Paris, France
| | - David Boulate
- Service de chirurgie thoracique, des maladies de l'œsophage et de transplantation pulmonaire, Assistance Publique Hopitaux de Marseille, Hôpital Nord, Marseille, France
| | - Aude Charvet
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Jacques Jougon
- Department of Thoracic Surgery, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Philippe Lacoste
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Le Plessis Robinson, France
| | - Philippe Portran
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Hadrien Roze
- Department of Anesthesiology and Critical Care, Haut-Leveque Hospital, Bordeaux University Hospital, Pessac, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hopital Foch, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Jacques Thes
- Department of Anesthesiology, Hôpital Marie-Lannelongue, Groupe hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
- Cardiothoracic Intensive Care Unit, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
| | - Francois Tronc
- Service de chirurgie thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard, Lyon 1, Lyon, France
| | - Mickael Vourc'h
- Service d'Anesthésie-Réanimation Chirurgie Cardiaque, Hôpital Laennec, CHU de Nantes, Nantes, France
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, Nantes, France
| | - Philippe Montravers
- Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
- Département d'Anesthésie et Réanimation, DMU PARABOL, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yves Castier
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Herve Mal
- Service de Pneumologie B et Transplantation Pulmonaire, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
| | - Pierre Mordant
- Physiopathology and Epidemiology of Respiratory Diseases, UMR1152, INSERM and Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation, APHP.Nord-Université de Paris, Hôpital Bichat-Claude Bernard, Paris, France
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Le Pavec J, Savale L, Prévot G, Montani D, Sitbon O, Fadel E, Humbert M, Mercier O. [Lung transplantation for severe pulmonary hypertension]. Rev Mal Respir 2023; 40 Suppl 1:e52-e57. [PMID: 36725440 DOI: 10.1016/j.rmr.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Le Pavec
- Service de Pneumologie et de Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue-Paris Saint-Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France.
| | - L Savale
- Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Service de Pneumologie, Hôpital Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - G Prévot
- Pôle des voies respiratoires-Hôpital Larrey, Centre Hopitalo-Universitaire, Toulouse, France
| | - D Montani
- Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Service de Pneumologie, Hôpital Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - O Sitbon
- Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Service de Pneumologie, Hôpital Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - E Fadel
- Service de Pneumologie et de Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue-Paris Saint-Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint-Joseph, Le Plessis-Robinson, France
| | - M Humbert
- Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint-Joseph, Le Plessis-Robinson, France; Service de Pneumologie, Hôpital Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - O Mercier
- Service de Pneumologie et de Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue-Paris Saint-Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint-Joseph, Le Plessis-Robinson, France
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Mordant P, Dauriat G, Brugière O, Borie R, Crestani B, Reynaud-Gaubert M. [Lung transplantation for fibrotic interstitial lung diseases]. Rev Mal Respir 2023; 40 Suppl 1:e42-e51. [PMID: 36610850 DOI: 10.1016/j.rmr.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- P Mordant
- Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France.
| | - G Dauriat
- Service de pneumologie, hôpital Marie-Lannelongue, groupe hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
| | - O Brugière
- Service de pneumologie, hôpital Foch, Suresnes, France
| | - R Borie
- Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France
| | - B Crestani
- Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France
| | - M Reynaud-Gaubert
- Service de pneumologie, équipe de transplantation pulmonaire, centre hospitalo-universitaire Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
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5
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Le Pavec J, Pison C, Hirschi S, Bunel V, Mordant P, Brugière O, Guen ML, Olland A, Coiffard B, Renaud-Picard B, Tissot A, Brioude G, Borie R, Crestani B, Deslée G, Stelianides S, Mal H, Schuller A, Falque L, Lorillon G, Tazi A, Burgel PR, Grenet D, De Miranda S, Bergeron A, Launay D, Cottin V, Nunes H, Valeyre D, Uzunhan Y, Prévot G, Sitbon O, Montani D, Savale L, Humbert M, Fadel E, Mercier O, Mornex JF, Dauriat G, Reynaud-Gaubert M. 2022 Update of indications and contraindications for lung transplantation in France. Respir Med Res 2022; 83:100981. [PMID: 36565563 DOI: 10.1016/j.resmer.2022.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Lung transplantation (LTx) is a steadily expanding field. The considerable developments have been driven over the years by indefatigable work conducted at LTx centers to improve donor and recipient selection, combined with multifaceted efforts to overcome challenges raised by the surgical procedure, perioperative care, and long-term medical complications. One consequence has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. The Francophone Pulmonology Society (Société de Pneumology de Langue Française, SPLF) set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force examined the most recent literature and evaluated the risk factors that limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while also improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.
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Affiliation(s)
- Jérôme Le Pavec
- Service de Pneumologie et Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France.
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France; INSERM 1055, Laboratoire de Bioénergétique Fondamentale et Appliquée, Bâtiment B Biologie, 2280 Rue de la piscine 38400 Saint Martin d'Hères, France; Université Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Sandrine Hirschi
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France
| | - Vincent Bunel
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP, Inserm U1152, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Pierre Mordant
- Service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Université de Paris, 46 Rue Henri Huchard, 75018, Paris, France
| | - Olivier Brugière
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Morgan Le Guen
- Département d'Anesthésie, Hôpital Foch, 40 Rue Worth, 92150 Suresnes, France; INRA UMR 892 VIM, équipe Vaccins Immunopathologie Immunomodulation, Domaine de Vilvert, 78350, Jouy-en-Josas, France; Université Versailles Saint Quentin, 45 Av. des États Unis, 78000 Versailles France
| | - Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France; INSERM (French institute for health and medical research) 1260 Regenerative, University Hospital Strasbourg, 1 place de l'hôpital, BP 426, 67091 Strasbourg, France
| | - Benjamin Coiffard
- Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Benjamin Renaud-Picard
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France; INSERM (French institute for health and medical research) 1260 Regenerative, University Hospital Strasbourg, 1 place de l'hôpital, BP 426, 67091 Strasbourg, France
| | - Adrien Tissot
- Nantes Université, CHU Nantes, Service de Pneumologie, l'institut du thorax, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 8 Quai Moncousu, 44007, Nantes, France
| | - Geoffrey Brioude
- Service de Chirurgie Thoracique, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Raphaël Borie
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Bruno Crestani
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Gaétan Deslée
- Service de Pneumologie, Inserm U1250, CHU Reims, Université Reims Champagne Ardenne, 45 Rue Cognacq-Jay, 51092, Reims, France
| | - Sandrine Stelianides
- Institut de réadaptation d'Achères, 7, place Simone-Veil, 78260, Achères, France
| | - Hervé Mal
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP, Inserm U1152, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Armelle Schuller
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France
| | - Loïc Falque
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Gwenaëlle Lorillon
- Université de Paris, INSERM UMR 976 HIPI, F-75006; Centre national de référence des histiocytoses, Service de Pneumologie, Hôpital Saint Louis, 1 Av. Claude Vellefaux, 75010, Paris, AP-HP, France
| | - Abdellatif Tazi
- Université de Paris, INSERM UMR 976 HIPI, F-75006; Centre national de référence des histiocytoses, Service de Pneumologie, Hôpital Saint Louis, 1 Av. Claude Vellefaux, 75010, Paris, AP-HP, France
| | - Pierre Regis Burgel
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France; Pulmonary Department and National Cystic Fibrosis Reference Centre, Cochin Hospital; Assistance Publique Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Dominique Grenet
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Sandra De Miranda
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland; Université de Paris, UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Parvis Notre-Dame - Pl. Jean-Paul II, 75004, Paris, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, rue Michel Polonowski, 5900, Lille, France; Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, rue Michel Polonowski, 5900, Lille France; Inserm, rue Michel Polonowski, 5900, Lille, France
| | - Vincent Cottin
- Université de Lyon, INRA, IVPC, Lyon; Centre national de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Hilario Nunes
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Dominique Valeyre
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Yurdagul Uzunhan
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Grégoire Prévot
- Pôle des voies respiratoires-Hôpital Larrey, Centre Hopitalo-Universitaire, 24 Chem. de Pouvourville, 31400, Toulouse, France
| | - Olivier Sitbon
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - David Montani
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Marc Humbert
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Elie Fadel
- Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Olaf Mercier
- Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Jean François Mornex
- Université de Lyon, université Lyon 1; PSL, EPHE; INRAE; IVPC; 69007, Lyon, France; Hospices civils de Lyon, GHE, service de pneumologie; RESPIFIL, Orphalung; Inserm, CIC1407, 59 Bd Pinel, 69500 Bron, France
| | - Gaëlle Dauriat
- Service de Pneumologie et Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
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6
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Phillips-Houlbracq M, Mal H, Cottin V, Gauvain C, Beier F, Sicre de Fontbrune F, Sidali S, Mornex JF, Hirschi S, Roux A, Weisenburger G, Roussel A, Wémeau-Stervinou L, Le Pavec J, Pison C, Marchand Adam S, Froidure A, Lazor R, Naccache JM, Jouneau S, Nunes H, Reynaud-Gaubert M, Le Borgne A, Boutboul D, Ba I, Boileau C, Crestani B, Kannengiesser C, Borie R. Determinants of survival after lung transplantation in telomerase-related gene mutation carriers: A retrospective cohort. Am J Transplant 2022; 22:1236-1244. [PMID: 34854205 DOI: 10.1111/ajt.16893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 01/25/2023]
Abstract
Carriers of germline telomerase-related gene (TRG) mutations can show poor prognosis, with an increase in common hematological complications after lung transplantation (LT) for pulmonary fibrosis. The aim of this study was to describe the outcomes after LT in recipients carrying a germline TRG mutation and to identify the predictors of survival. In a multicenter cohort of LT patients, we retrospectively reviewed those carrying pathogenic TRG variations (n = 38; TERT, n = 23, TERC, n = 9, RTEL1, n = 6) between 2009 and 2018. The median age at LT was 54 years (interquartile range [IQR] 46-59); 68% were male and 71% had idiopathic pulmonary fibrosis. During the diagnosis of pulmonary fibrosis, 28 (74%) had a hematological disease, including eight with myelodysplasia. After a median follow-up of 26 months (IQR 15-46), 38 patients received LT. The overall post-LT median survival was 3.75 years (IQR 1.8-NA). The risk of death after LT was increased for patients with myelodysplasia (HR 4.1 [95% CI 1.5-11.5]) or short telomere (HR 2.2 [1.0-5.0]) before LT. After LT, all patients had anemia, 66% had thrombocytopenia, and 39% had neutropenia. Chronic lung allograft dysfunction frequency was 29% at 4 years. The present findings support the use of LT in TRG mutation carriers without myelodysplasia. Hematological evaluation should be systematically performed before LT.
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Affiliation(s)
- Mathilde Phillips-Houlbracq
- Service de Pneumologie A, Centre de référence des maladies pulmonaires rares (site constitutif), APHP, Hôpital Bichat, Paris, France
| | - Hervé Mal
- Université de Paris and INSERM U1152, Paris, France.,Service de Pneumologie B, APHP, Hôpital Bichat, Paris, France
| | - Vincent Cottin
- Service de Pneumologie, Centre coordonnateur national de référence des maladies pulmonaires rares, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Université de Lyon, INRAE, ERN-LUNG, Lyon, France
| | - Clément Gauvain
- Service d'oncologie, Hôpital Calmette, CHU de Lille, Lille, France
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | | | - Sabrina Sidali
- Service d'hépatologie, Hôpital Beaujon, APHP, Clichy, France
| | - Jean François Mornex
- Service de Pneumologie, Centre coordonnateur national de référence des maladies pulmonaires rares, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Université de Lyon, INRAE, ERN-LUNG, Lyon, France
| | - Sandrine Hirschi
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Antoine Roux
- Service de Pneumologie, Hôpital Foch, Suresnes, France
| | - Gaelle Weisenburger
- Université de Paris and INSERM U1152, Paris, France.,Service de Pneumologie B, APHP, Hôpital Bichat, Paris, France
| | - Arnaud Roussel
- Service de chirurgie vasculaire et thoracique, Hopital Bichat, Paris, France
| | - Lidwine Wémeau-Stervinou
- Service de Pneumologie, Centre de référence des maladies pulmonaires rares (site constitutif), CHU de Lille, Lille, France
| | - Jérôme Le Pavec
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Groupe Hospitalier Saint Joseph/Marie-Lannelongue, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | | | - Antoine Froidure
- Service de pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - Romain Lazor
- Service de Pneumologie, Centre hospitalier universitaire vaudois, Lausanne, Suisse
| | - Jean-Marc Naccache
- Service de Pneumologie, Centre de référence des maladies pulmonaires rares (site constitutif), Hôpital Tenon, Paris, France
| | - Stéphane Jouneau
- Service de Pneumologie, Centre de compétences des maladies rares pulmonaires, Hôpital Pontchaillou, IRSET UMR 1085, Université de Rennes 1, Rennes, France
| | - Hilario Nunes
- Service de Pneumologie Centre de référence des maladies pulmonaires rares (site constitutif), Hôpital Avicenne, Bobigny, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, Centre de compétences des maladies pulmonaires rares, CHU Nord, AP-HM, Marseille, France.,Aix-Marseille Université, IHU Méditerranée Infection, MEPHI, Marseille, France
| | - Aurélie Le Borgne
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares Hôpital Larrey CHU Toulouse, Toulouse, France
| | - David Boutboul
- Service d'Immunopathologie Clinique, Hôpital St Louis, APHP, Paris, France
| | - Ibrahima Ba
- Laboratoire de Génétique, APHP, Hôpital Bichat, Paris, France
| | | | - Bruno Crestani
- Service de Pneumologie A, Centre de référence des maladies pulmonaires rares (site constitutif), APHP, Hôpital Bichat, Paris, France
| | | | - Raphaël Borie
- Service de Pneumologie A, Centre de référence des maladies pulmonaires rares (site constitutif), APHP, Hôpital Bichat, Paris, France
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7
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Gottlieb J, Lepper PM, Berastegui C, Montull B, Wald A, Parmar J, Magnusson JM, Schönrath F, Laisaar T, Michel S, Larsson H, Vos R, Haneya A, Sandhaus T, Verschuuren E, le Pavec J, Tikkanen J, Hoetzenecker K. Lung transplantation for acute respiratory distress syndrome - a retrospective European Cohort Study. Eur Respir J 2021; 59:13993003.02078-2021. [PMID: 34824051 DOI: 10.1183/13993003.02078-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The published experience of lung transplantation (LTX) in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of LTX attempts in ARDS in major European centers. METHODS We conducted a retrospective multicenter cohort study of all patients listed for LTX between 2011 and 2019. We surveyed 68 centers in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of "ARDS//pneumonia" were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until October 1st 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation were performed. RESULTS Forty-eight centers (74%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. Forty patients with a median age of 35 years were identified. Patients were listed for LTX in 18 different centers in 10 countries. Thirty-one-patients underwent LTX (0·25% of all indications) and 9 patients died on the waitlist. Ninety percent of transplanted patients were on ECMO in combination with mechanical ventilation before LTX. On multivariable analysis, transplantation during 2015 until 2019 was independently associated with better 1-year survival after LTX (odds ratio 10.493, 95% CI 1.977, 55.705, p=0.006). Sixteen survivors out of 23 patients with known status (70%) returned to work after LTX. CONCLUSION LTX in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hanover, Germany .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp M Lepper
- Dept. of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, University Hospital of Saarland, and Saarland University, Homburg, Germany
| | - Cristina Berastegui
- Department of Respiratory Medicine, Lung Transplant Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Beatriz Montull
- Department of Respiratory Medicine and Lung Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alexandra Wald
- Department of Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Jasvir Parmar
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jesper M Magnusson
- Department of respiratory medicine, Institute of Medicine, University of Gothenburg, Transplant Institue, Sahlgrenska university hospital
| | - Felix Schönrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tanel Laisaar
- Department of Thoracic Surgery and Lung Transplantation, Lung Clinic, Tartu University Hospital; Lung Clinic, Tartu University
| | - Sebastian Michel
- Department of Cardiac Surgery, Ludwig Maximilian University Munich and Comprehensive Pneumology Center (CPC)-Munich, Member of the German Center for Lung Research (DZL)
| | - Hillevi Larsson
- Departement of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven - Campus Gasthuisberg, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Kiel, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Erik Verschuuren
- University Medical Center Groningen, Respiratory diseases, and Lung Transplantation, Groningen, The Netherlands
| | - Jérôme le Pavec
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Jussi Tikkanen
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Both authors contributed equally
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Austria.,Both authors contributed equally
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8
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Lanera C, Ocagli H, Schiavon M, Dell’Amore A, Bottigliengo D, Bartolotta P, Acar AS, Lorenzoni G, Berchialla P, Baldi I, Rea F, Gregori D. The Surplus Transplant Lung Allocation System in Italy: An Evaluation of the Allocation Process via Stochastic Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137132. [PMID: 34281067 PMCID: PMC8296876 DOI: 10.3390/ijerph18137132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
Background: Lung transplantation is a specialized procedure used to treat chronic end-stage respiratory diseases. Due to the scarcity of lung donors, constructing fair and equitable lung transplant allocation methods is an issue that has been addressed with different strategies worldwide. This work aims to describe how Italy’s “national protocol for the management of surplus organs in all transplant programs” functions through an online app to allocate lung transplants. We have developed two probability models to describe the allocation process among the various transplant centers. An online app was then created. The first model considers conditional probabilities based on a protocol flowchart to compute the probability for each area and transplant center to receive each n-th organ in the period considered. The second probability model is based on the generalization of the binomial distribution to correlated binary variables, which is based on Bahadur’s representation, to compute the cumulative probability for each transplant center to receive at least nth organs. Our results show that the impact of the allocation of a surplus organ depends mostly on the region where the organ was donated. The discrepancies shown by our model may be explained by a discrepancy between the northern and southern regions in relation to the number of organs donated.
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Affiliation(s)
- Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | - Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | - Marco Schiavon
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy; (M.S.); (A.D.); (F.R.)
| | - Andrea Dell’Amore
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy; (M.S.); (A.D.); (F.R.)
| | - Daniele Bottigliengo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | | | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, 10043 Orbassano, Italy;
| | - Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
| | - Federico Rea
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy; (M.S.); (A.D.); (F.R.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (C.L.); (H.O.); (D.B.); (P.B.); (G.L.); (I.B.)
- Correspondence: ; Tel.: +39-049-8275384
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9
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Coriati A, Sykes J, Lemonnier L, Ma X, Stanojevic S, Dehillotte C, Carlier N, Stephenson AL, Burgel PR. The impact of the high emergency lung transplantation program in cystic fibrosis in France: insight from a comparison with Canada. Eur Respir J 2021; 59:13993003.00014-2021. [PMID: 34140297 DOI: 10.1183/13993003.00014-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION France implemented a high emergency lung transplantation (HELT) program nationally in 2007. A similar program does not exist in Canada. The objectives of our study were to compare health outcomes within France as well as between Canada and France before and after the HELT program in a population with Cystic Fibrosis (CF). METHODS This population-based cohort study utilised data from the French and Canadian CF registries. A cumulative incidence curve assessed time to transplant with death without transplant as competing risks. The Kaplan-Meier method was used to estimate post-transplant survival. RESULTS Between 2002 and 2016, there were 1075 (13.0%) people with CF in France and 555 (10.2%) people with CF in Canada who underwent lung transplantation. The proportion of lung transplant increased in France after the HELT program was initiated (4.5% versus 10.1%) whereas deaths pre-transplant decreased from 85.3% in the pre-HELT to 57.1% in the post-HELT period. Between 2008-2016, people in France were significantly more likely to receive a transplant (Hazard Ratio (HR) 1.56, 95% CI 1.37-1.77, p<0.001) than die (HR 0.55, 95% CI 0.46-0.66, p<0.001) compared to Canada. Post-transplant survival was similar between the countries and there was no difference in survival when comparing pre- and post-HELT period in France. CONCLUSION Following the implementation of the HELT program, people living with CF in France were more likely to receive a transplant than die. Post-transplant survival in the post-HELT period in France did not change compared to the pre-HELT period, despite potentially sicker patients being transplanted, and is comparable to Canada.
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Affiliation(s)
- Adèle Coriati
- Department of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jenna Sykes
- Department of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Xiayi Ma
- Department of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Nicolas Carlier
- Hôpital Cochin, Assistance Publique Hopitaux de Paris, Paris, France.,ERN-Lung Cystic Fibrosis network
| | - Anne L Stephenson
- Department of Respirology, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.,Co-senior authors
| | - Pierre-Régis Burgel
- Hôpital Cochin, Assistance Publique Hopitaux de Paris, Paris, France .,ERN-Lung Cystic Fibrosis network.,Université de Paris and Institut Cochin, Inserm U1016, Paris, France.,Co-senior authors
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10
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van der Mark SC, Hoek RAS, Hellemons ME. Developments in lung transplantation over the past decade. Eur Respir Rev 2020; 29:190132. [PMID: 32699023 PMCID: PMC9489139 DOI: 10.1183/16000617.0132-2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.
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Affiliation(s)
- Sophie C van der Mark
- Dept of Pulmonary Medicine, Division of Interstitial Lung Disease, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
- Authors contributed equally
| | - Rogier A S Hoek
- Dept of Pulmonary Medicine, Division of Lung Transplantation, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
- Authors contributed equally
| | - Merel E Hellemons
- Dept of Pulmonary Medicine, Division of Interstitial Lung Disease, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
- Dept of Pulmonary Medicine, Division of Lung Transplantation, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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11
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12
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Interstitial lung diseases in the 2020s. Presse Med 2020; 49:104022. [PMID: 32387530 DOI: 10.1016/j.lpm.2020.104022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Holm AM, Immer F, Benden C. Lung allocation for transplant: The European perspective. Clin Transplant 2020; 34:e13883. [PMID: 32294267 DOI: 10.1111/ctr.13883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 01/03/2023]
Abstract
Since the first successful lung transplants in humans were done in the 1980s, lung transplantation has become an established treatment for end-stage pulmonary disease. Because the access to transplantable organs is limited and unpredictable, rules that guide the allocation of lungs for transplants have emerged. Such rules are governed not only by medical and bioethical necessities, but also by local traditions, legislation, and practical circumstances. Therefore, there may be significant differences between the organ allocation practices in various parts of the world. In this brief communication, the European perspective on lung allocation is presented, also adding a very brief description of other parts of the world.
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Affiliation(s)
- Are Martin Holm
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Christian Benden
- Swisstransplant, Berne, Switzerland.,University of Zurich Medical Faculty, Zürich, Switzerland
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14
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Holm AM, Gottlieb J. Saving those who can't wait. Eur Respir J 2019; 54:54/5/1901668. [DOI: 10.1183/13993003.01668-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/05/2022]
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