Lung transplantation for acute respiratory distress syndrome: a retrospective European cohort study.

BACKGROUND

The published experience of lung transplantation in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of lung transplantation attempts in ARDS in major European centres.

METHODS

We conducted a retrospective multicentre cohort study of all patients listed for lung transplantation between 2011 and 2019. We surveyed 68 centres in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of "ARDS/pneumonia" were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until 1 October 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation was performed.

RESULTS

55 centres (81%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. 40 patients with a median age of 35 years were identified. Patients were listed for lung transplantation in 18 different centres in 10 countries. 31 patients underwent lung transplantation (0.25% of all indications) and nine patients died on the waitlist. 90% of transplanted patients were on ECMO in combination with mechanical ventilation before lung transplantation. On multivariable analysis, transplantation during 2015-2019 was independently associated with better 1-year survival after lung transplantation (OR 10.493, 95% CI 1.977-55.705; p=0.006). 16 survivors out of 23 patients with known status (70%) returned to work after lung transplantation.

CONCLUSIONS

Lung transplantation in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging.

Informations de copyright

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Déclaration de conflit d'intérêts

Conflict of interest: J. Gottlieb reports grants from the German Center for Lung Research (DZL), during the conduct of the study; grants from Deutsche Forschungsgemeinschaft (DFG) and from Breath Therapeutics, personal fees from Novartis, outside the submitted work. Conflict of interest: P.M. Lepper has nothing to disclose. Conflict of interest: C. Berastegui has nothing to disclose. Conflict of interest: B. Montull has nothing to disclose. Conflict of interest: A. Wald has nothing to disclose. Conflict of interest: J. Parmar reports nonfinancial support from Breath Therapeutics, outside the submitted work. Conflict of interest: J.M. Magnusson reports personal fees from GSK, grants and personal fees from Boehringer Ingelheim, outside the submitted work. Conflict of interest: F. Schönrath reports grants from Novartis and Abbott, nonfinancial support from Medtronic, other from AstraZeneca and Orion Pharma, outside the submitted work. Conflict of interest: T. Laisaar has nothing to disclose. Conflict of interest: S. Michel reports grants from the German Center for Lung Research (DZL), during the conduct of the study; grants from Deutsche Forschungsgemeinschaft (DFG), outside the submitted work. Conflict of interest: H. Larsson has nothing to disclose. Conflict of interest: R. Vos reports grants from Research Foundation-Flanders (FWO), outside the submitted work. Conflict of interest: A. Haneya has nothing to disclose. Conflict of interest: T. Sandhaus has nothing to disclose. Conflict of interest: E. Verschuuren has nothing to disclose. Conflict of interest: J. le Pavec has nothing to disclose. Conflict of interest: J. Tikkanen reports personal fees from Astellas Pharma, GSK pharma and CSL Behring, outside the submitted work. Conflict of interest: K. Hoetzenecker reports grants from FWF Austria, personal fees from Medtronic, outside the submitted work.