Long-term survival after High-Urgent lung transplantation: a single center analysis

<bold>Background:</bold> High-Urgent (HU) lung transplantation (LTx) is a life-saving treatment for highly selected patients with respiratory failure. <bold>Aims and Methods:</bold> Retrospective analysis of post-LTx survival in patients who underwent HU LTx between January 1st 2014, and January 31st 2024 in a large-volume lung transplant center. <bold>Results:</bold> A total of 70 patients underwent HU LTx (39 Male/31 Female, 67 bilateral lung/2 heart-lung/1 combined liver-lungs, 6 redo-LTx), n=10 for obstructive disease (group A), n=8 for vascular disease (group B), n=10 for suppurative disease (group C), and n=42 for restrictive disease (group D). Median (IQR) age at LTx was 52 (37.8-59.3) years, BMI 23.6 (18.4-26.3), LAS score 63 (42.8-78.5), waiting list duration 42.5 (6-196) days, and HU-status 7 (2-12) days. At HU LTx, 12 patients (17%) were mechanically ventilated (MV), 9 patients (13%) were on extracorporeal life support (ECLS) alone, and 18 (26%) on both MV and ECLS, while the remaining n=31 (44%) were on nasal high flow oxygen or non-invasive ventilatory support. 20 patients (29%) were HLA-sensitized, in 9 of whom DSA were present, with a median IgG CDC-PRA of 0 (0-4.5)%. Median post-LTx follow-up is 675.5 (298.8-1690.0) days (range 6-3679), and 27 patients (39%) meanwhile have died, after a median of 579 (155-1326) days post-LTx. Overall post-LTx survival was 84.6% at 1 year, 66.9% at 3 years, and 49.6% at 5 years, but differed with age (≤50 vs. >50 y, p=0.002), need for invasive support (no vs. ECLS±MV, p=0.0362), and tended to differ with HLA-sensitization (p=0.0945). <bold>Conclusions:</bold> Long-term survival after HU LTx is limited, especially in recipients above 50 years, requiring invasive support, or with HLA-sensitization.