Characteristics of Lung Allocation and Outcomes of Lung Transplant according to the Korean Urgency Status
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초록
Purpose: We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgencystatus. Materials and Methods: LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 toJune 2017, 86 patients who received LTx were enrolled in KOTRY. After excluding one patient who received a heart-lung transplant,85 were included. Subjects were analyzed according to the Korean urgency status. Results: Except for Status 0, urgency status was classified based on partial pressure of oxygen in arterial blood gas analysis andfunctional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status1, 104.4±98.2 days; Status 2 or 3, 132.2±118.4 days, p=0.009). Status 0 was associated with increased operative times and higherintraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperativebleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status0 patients, although differences were not significant. Conclusion: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflectionof urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite havingthe highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation systemto reflect true urgency and provide the best benefit of lung transplantation.
Abstract
Purpose: We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgencystatus. Materials and Methods: LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 toJune 2017, 86 patients who received LTx were enrolled in KOTRY. After excluding one patient who received a heart-lung transplant,85 were included. Subjects were analyzed according to the Korean urgency status. Results: Except for Status 0, urgency status was classified based on partial pressure of oxygen in arterial blood gas analysis andfunctional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status1, 104.4±98.2 days; Status 2 or 3, 132.2±118.4 days, p=0.009). Status 0 was associated with increased operative times and higherintraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperativebleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status0 patients, although differences were not significant. Conclusion: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflectionof urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite havingthe highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation systemto reflect true urgency and provide the best benefit of lung transplantation.
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