Impact of High-emergency Lung Transplantation Procedure on 1-y Survival in France

BACKGROUND: In France, a priority rule called high-emergency lung transplantation (HELT) was implemented in 2007 to lower the risk of mortality while on the waitlist for LT for the sickest patients. However, allowing rapid access to LT and lowering the waitlist mortality was at the expense of worse outcomes compared with regular allocation. The aim of the study was to provide actualized data on the results of HELT in France. METHODS: Using exhaustive data from the French organ procurement organization, we performed a retrospective analysis by selecting patients who underwent LT from January 1, 2018, to December 31, 2023, across all 10 French LT centers. The main end point was 1-y post-LT survival in the HELT versus the standard LT allocation group. RESULTS: We selected 1085 patients who underwent LT according to HELT priority (n = 325, 30% of the LTs) or standard LT following a regular graft allocation (n = 760) during the study period. Survival at 3, 6, and 12 mo after LT was 90.3%, 86.7%, and 82.7% versus 87.7%, 83%, and 77.6% in the standard LT and the HELT groups, respectively (P = 0.046). On multivariable analysis, HELT was not found to be associated with increased risk of 1-y mortality but was found to be associated with increased postoperative morbidity. CONCLUSIONS: Although previous reports indicated that HELT was associated with a worse prognosis than standard LT, this appears to no longer to be the case.