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

Yonsei Medical Journal 2019년 60권 10호 p.992 ~ 997
 ( Yu Woo-Sik ) - Ajou University School of Medicine Department of Thoracic and Cardiovascular Surgery

 ( Kim Song-Yee ) - Yonsei University College of Medicine Severance Hospital Department of Internal Medicine
 ( Kim Young-Tae ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
 ( Lee Hyun-Joo ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
 ( Park Samina ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
 ( Choi Sun-Mi ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
 ( Kim Do-Hyung ) - Pusan National University Yangsan Hospital Department of Thoracic and Cardiovascular Surgery
 ( Cho Woo-Hyun ) - Pusan National University Yangsan Hospital Department of Pulmonology and Critical Care Medicine
 ( Yeo Hye-Ju ) - Pusan National University Yangsan Hospital Department of Pulmonology and Critical Care Medicine
 ( Park Seung-Il ) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
최세훈 ( Choi Se-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
 ( Hong Sang-Bum ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
심태선 ( Shim Tae-Sun ) - University of Ulsan College of Medicine Asan Medical Center Division of Pulmonary and Critical Care Medicine
 ( Jo Kyung-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
 ( Jeon Kyeong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Jeong Byeong-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Paik Hyo-Chae ) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
 ( Lee Jin-Gu ) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery

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.

키워드

Lung transplant; lung allocation; post-transplant survival
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