The Hidden Gem: The Costa Rica Lung Transplant Program

<bold>Purpose:</bold> more than 4000 lung transplants (LTx) are performed yearly around the world. However, there is only one transplant center in Central America. We aimed to characterize the epidemiology of our LTx recipients and to describe the outcomes of the program. <bold>Methods:</bold> This study includes all first-time, adult LTx recipients from 2019-July 2023 were included in this study. We conducted a comprehensive analysis of the data using descriptive statistics. <bold>Results:</bold> During the last 4 years, our center has performed 14 bilateral LTx of which 57% were female. The primary indication was Interstitial Lung Disease in 77% of cases, while emphysema, combined pulmonary fibrosis, and emphysema and bronchiectasis accounted for the remaining cases, each at 7%. The recipient's mean age was 46 years, ranging from 27 to 65 years. At the time of transplant, 7% of recipients were Cytomegalovirus recipients -, and 21% required the Toronto Desensitation Protocol (plasmapheresis, immunoglobulin, and thymoglobulin) due to a positive Virtual Crossmatch. 7% were bridge to transplant and 29% required post-op ECMO. 60% developed primary graft dysfunction grade 3 at 72 hours. The 30 days survival was 86% and the 1 year survival was 79%. Only one patient required temporary renal replacement therapy. The average of days of hospitalizations was 32. Among the patients alive beyond 6 months, 12.5% developed chronic allograft dysfunction at 18 months and 12.5% developed low baseline allograft dysfunction. Additionally, 21% of recipients experience acute cellular rejection. <bold>Conclusion:</bold> This study demonstrates that even LTx is a complex procedure, our small program has made significant progress in providing Central American patients with first-world opportunities.