Urgently Listed Lung Transplant Patients Have Outcomes Similar to Those of Electively Listed Patients

Abstract Objectives To 1) determine outcomes after urgent listing compared with elective listing for lung transplant and 2) compare in-hospital morbidity and mortality, survival, and allograft function in these 2 groups. Methods From 1/2006 to 9/2017, 201 patients were urgently and 1,423 electively listed. Among urgently listed patients, 130 subsequently underwent primary lung transplant as did 995 electively listed patients. Competing-risks analysis for death and transplant after listing and weighted balancing score matching (76 pairs) were used to compare in-hospital morbidity and survival. Mixed-effect longitudinal modeling was used to compare allograft function to 8 years post-transplant. Results At 1 month, mortality was 26% in urgently listed patients, and 58% were transplanted. Risk factors for death included older age, higher bilirubin, and transfer from an outside hospital. At transplantation, urgently listed transplant patients were younger (53±13 vs 55±12 years), had more ventilator and extracorporeal (ECMO) support (32/25% vs 20/2.0%), more restrictive lung disease (95/73% vs 509/51%), and a higher lung allocation score (82±13 vs 47±17). In-hospital morbidity and mortality, time-related survival, and longitudinal allograft function were similar between matched groups. Conclusions Urgent listing more often than not leads to transplantation. Although urgently listed patients are sicker overall, after transplant their perioperative morbidity and mortality, overall survival, and allograft function are similar to those of electively listed patients. Appropriate patient selection and aggressive supportive care allow urgently listed lung transplant patients to achieve these similar post-transplant outcomes.