Survival outcomes following urgent lung transplantation in France and the USA.

Autor:	Roussel A; Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France arnaud.roussel@aphp.fr., Sage E; Department of Thoracic Surgery and Lung Transplantation, Hopital Foch, Suresnes, France., Falcoz PE; Department of Thoracic Surgery and Lung Transplantation, Strasbourg University Hospitals, Strasbourg, France., Thomas PA; Thoracic Surgery Department, Aix-Marseille-University, Marseille, France., Castier Y; Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France., Fadel E; 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., Le Pimpec-Barthes F; Thoracic Surgery and Lung Transplantation, Hopital Europeen Georges Pompidou, Paris, France.; Universite Paris Descartes Faculte de Medecine, Paris, France., Tronc F; Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Centre Hospitalier Universitaire de Lyon, Lyon, France., Jougon J; Department of Thoracic Surgery and Lung Transplantation, CHU de Bordeaux, Bordeaux, France., Lacoste P; Department of Thoracic Surgery and Lung Transplantation, Hopital Nord Laennec, Nantes, France., Claustre J; Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France., Brouchet L; Thoracic Surgery Department, University Hospital CHU Toulouse, Toulouse, France., Dorent R; Agence de la Biomédecine, Saint Denis, France., Cantu E; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Harhay M; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Porcher R; Department of Biostatistics and Epidemiology, Inserm U1153, Paris, France., Mordant P; Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2024 Jul 16; Vol. 79 (8), pp. 745-753. Date of Electronic Publication: 2024 Jul 16.
DOI:	10.1136/thorax-2023-220847
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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