Roux Antoine, Beaumont-Azuar Laurence, Hamid Abdul Monem, De Miranda Sandra, Grenet Dominique, Briend Guillaume, Bonnette Pierre, Puyo Philippe, Parquin François, Devaquet Jerome, Trebbia Gregoire, Cuquemelle Elise, Douvry Benoit, Picard Clément, Le Guen Morgan, Chapelier Alain, Stern Marc, Sage Edouard
Pneumology Department, Foch Hospital, Suresnes, France.
UPRES EA220, Université de Versailles Saint-Quentin-en-Yvelines, Suresnes, France.
Transpl Int. 2015 Sep;28(9):1092-101. doi: 10.1111/tri.12604. Epub 2015 May 27.
Many candidates for lung transplantation (LT) die on the waiting list, raising the question of graft availability and strategy for organ allocation. We report the experience of the new organ allocation program, "High Emergency Lung Transplantation" (HELT), since its implementation in our center in 2007. Retrospective analysis of 201 lung transplant patients, of whom 37 received HELT from 1st July 2007 to 31th May 2012. HELT candidates had a higher impairment grade on respiratory status and higher Lung Allocation Score (LAS). HELT patients had increased incidence of perioperative complications (e.g., perioperative bleeding) and extracorporeal circulatory assistance (75% vs. 36.6%, P = 0.0005). No significant difference was observed between HELT and non-HELT patients in mechanical ventilation duration (15.5 days vs. 11 days, P = 0.27), intensive care unit length of stay (15 days vs. 10 days, P = 0.22) or survival rate at 12 (81% vs. 80%), and 24 months post-LT (72.9% vs. 75.0%). Lastly, mortality on the waiting list was spectacularly reduced from 19% to 2% when compared to the non-HELT 2004-2007 group. Despite a more severe clinical status of patients on the waiting list, HELT provided similar results to conventional LT. These results were associated with a dramatic reduction in the mortality rate of patients on the waiting list.
许多肺移植（LT）候选人在等待名单上死亡，这引发了移植物可用性和器官分配策略的问题。我们报告了新的器官分配计划“高紧急肺移植”（HELT）自2007年在我们中心实施以来的经验。对201例肺移植患者进行回顾性分析，其中37例在2007年7月1日至2012年5月31日期间接受了HELT。HELT候选人的呼吸状态损害等级更高，肺分配评分（LAS）也更高。HELT患者围手术期并发症（如围手术期出血）和体外循环辅助的发生率增加（75%对36.6%，P = 0.0005）。在机械通气时间（15.5天对11天，P = 0.27）、重症监护病房住院时间（15天对10天，P = 0.22）或LT后12个月（81%对80%）和24个月（72.9%对75.0%）的生存率方面，HELT患者与非HELT患者之间未观察到显著差异。最后，与2004 - 2007年非HELT组相比，等待名单上的死亡率从19%大幅降至2%。尽管等待名单上患者的临床状况更为严重，但HELT与传统LT的结果相似。这些结果与等待名单上患者死亡率的显著降低相关。
