Long-term survival of lung transplant recipients transplanted from ICU: a multicentre study

C.T. Gan, M.E. Hellemons, M.E. Erasmus, J.M. Droogh, D. Dos Reis Miranda, R.A.S. Hoek, W. van der Bij, E.A.M. Verschuuren

Wednesday 4 march 2020

12:30 - 12:40h at Theaterzaal

Parallel session: Plenaire sessie II - Best abstracts

Background: Lung transplantation (LTx) from ICU in patients with respiratory failure remains debated. Specifically in patients without an active lung transplant listing status. We compared long-term survival in patients transplanted from ICU with patients transplanted electively from the waiting list.

Methods: In this retrospective multicentre study patients from the University Medical Center Groningen and the Erasmus Medical Center Rotterdam were included from April 2004-December 2018 with a single, bilateral or heart- lung transplantation, and stratified by LTx from ICU or electively. Survival was assessed by Wilcoxon rank-tests. Parameters between groups were compared by Mann-Whitney U-test.

Results: A total of 595 patients had a single (n = 110), bilateral (n = 475) or heart-lung transplant (n = 10), 70 were transplanted from ICU (4 single and 66 bilateral LTx). Thirty-one out of 70 had no previous waiting list status and were assessed and listed for LTx on ICU. Patients transplanted from ICU were younger [ICU vs Elective; 49.8 (17.8-66.2) vs 54.3 (12.5-69.2) years, p<0.01]. Mechanical support was either mechanical ventilation n = 41 (58.6%), ECMO n = 29 (41.4%) or a combination. The length of stay on ICU pre-transplant was 25.5 (1-110) days. Patients electively transplanted stayed shorter on ICU [ICU; 18 (0-192) days vs. Elective; 5 (0-242) days, p < 0.001] and total hospital time after LTx was shorter [ICU; 52 (17-230) days vs. Elective; 32 (1-286) days, p <0.001]. One-year survival in the elective group (90.8%) and the group transplanted from ICU (90.9%) was not different. Long-term survival of patients transplanted from ICU was not different from the elective group. In addition, patients transplanted from ICU with a previous listing status compared to patients assessed, listed and transplanted from ICU had comparable long-term survival.

Conclusions: In this large multicentre Dutch cohort LTx from the ICU results in similar long-term outcome in comparison with elective lung transplantation. In addition, long-term survival in patients without an active lung transplant waiting list status and therefore assessed, listed and transplanted from ICU had good comparable long-term outcome.