[Emergency lung transplantation]

Lung donors are scarce and lung transplantation resources limited, leading to a need to look at transplants in terms of efficiency. Because emergency transplants (C-0) are assumed to yield poor results, most countries do not perform them on a regular basis. Spain, however does accept the concept of emergency lung transplantation for patients who are on waiting lists. We assess outcome for our patients who have received scheduled and emergency transplants.

The survival of patients receiving lung transplants in our service from 1992 through 2001 was studied using, Kaplan-Meier, Cox regression and chi-squared statistical analyses. We compared outcome and perioperative mortality (over 30 days) for scheduled versus C-0 procedures, analyzing the influence of certain variables (age, sex, emergency status, type of transplant, mechanical ventilation and use of extracorporeal membrane oxygenation).

Eleven of 183 lung transplants were C-0 and 172 were scheduled. Forty-one were single-lung and 142 were double-lung transplants. Perioperative mortality was 36.4% for emergency procedures and 8.7% for scheduled procedures (p = 0.0035). Survival was significantly better for scheduled patients than for C-0 patients (p = 0.0032), although outcome was similar when perioperative mortality was not taken into account (58.16% vs. 57.14% at 5 years for scheduled and C-0 patients, respectively).

Long-term survival after lung transplantation shows that the procedure is effective and efficient in C-0 patients, in spite of perioperative risk, provided the patient has been adequately monitored.