Yonsei Med J.  2019 Oct;60(10):992-997. 10.3349/ymj.2019.60.10.992.

Characteristics of Lung Allocation and Outcomes of Lung Transplant according to the Korean Urgency Status

• Yu WS
• Kim SY
• Kim YT
• Lee HJ
• Park S
• Choi SM
• Kim DH
• Cho WH
• Yeo HJ
• Park SI
• Choi SH
• Hong SB
• Shim TS
• Jo KW
• Jeon K
• Jeong BH
• Paik HC
• Lee JG
• the Korean Organ Transplantation Registry Study Group

• KMID: 2459153
• DOI: http://doi.org/10.3349/ymj.2019.60.10.992

Abstract

PURPOSE
We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgency status.
MATERIALS AND METHODS
LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 to June 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 and functional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status 1, 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 higher intraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperative bleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status 0 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 reflection of urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite having the highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation system to reflect true urgency and provide the best benefit of lung transplantation.

Keyword

Lung transplant; lung allocation; post-transplant survival

MeSH Terms

Allografts
Blood Gas Analysis
Blood Transfusion
Classification
Extracorporeal Membrane Oxygenation
Hemorrhage
Humans
Lung Transplantation
Lung*
Operative Time
Organ Transplantation
Oxygen
Partial Pressure
Respiration, Artificial
Tissue Donors
Transplants
Oxygen

Figure

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  Fig. 1 Survival curves of Status 0 and non-Status 0 patients.

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