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Original research
Survival outcomes following urgent lung transplantation in France and the USA
  1. Arnaud Roussel1,
  2. Edouard Sage2,
  3. Pierre-Emmanuel Falcoz3,
  4. Pascal Alexandre Thomas4,
  5. Yves Castier1,
  6. Elie Fadel5,6,7,
  7. Françoise Le Pimpec-Barthes8,9,
  8. François Tronc10,
  9. Jacques Jougon11,
  10. Philippe Lacoste12,
  11. Johanna Claustre13,
  12. Laurent Brouchet14,
  13. Richard Dorent15,
  14. Edward Cantu16,
  15. Michael Harhay17,
  16. Raphaël Porcher18,
  17. Pierre Mordant1
  1. 1Department of Vascular and Thoracic Surgery and Lung Transplantation, Hôpital Bichat Claude-Bernard, Paris, France
  2. 2Department of Thoracic Surgery and Lung Transplantation, Hopital Foch, Suresnes, France
  3. 3Department of Thoracic Surgery and Lung Transplantation, Strasbourg University Hospitals, Strasbourg, France
  4. 4Thoracic Surgery Department, Aix-Marseille-University, Marseille, France
  5. 5University Paris, Saclay, France
  6. 6Hôpital Marie Lannelongue, Le Plessis-Robinson, France
  7. 7Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis, France
  8. 8Thoracic Surgery and Lung Transplantation, Hopital Europeen Georges Pompidou, Paris, France
  9. 9Universite Paris Descartes Faculte de Medecine, Paris, France
  10. 10Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Centre Hospitalier Universitaire de Lyon, Lyon, France
  11. 11Department of Thoracic Surgery and Lung Transplantation, CHU de Bordeaux, Bordeaux, France
  12. 12Department of Thoracic Surgery and Lung Transplantation, Hopital Nord Laennec, Nantes, France
  13. 13Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
  14. 14Thoracic Surgery Department, University Hospital CHU Toulouse, Toulouse, France
  15. 15Agence de la Biomédecine, Saint Denis, France
  16. 16University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  17. 17Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  18. 18Department of Biostatistics and Epidemiology, Inserm U1153, Paris, France
  1. Correspondence to Dr Arnaud Roussel, Hôpital Bichat Claude-Bernard, Paris 75018, France; arnaud.roussel{at}


Introduction Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT).

Methods US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT performed between 2007 and 2017. We analysed the mortality risk of urgent LT by fitting Cox models and adjusted Restricted Mean Survival Time. We then compared the outcome after urgent LT in the UNOS and Cristal groups using a propensity score matching.

Results After exclusion of patients with chronic obstructive pulmonary disease/emphysema and redo LT, 3775 and 12 561 patients underwent urgent LT and non-urgent LT in the USA while 600 and 2071 patients underwent urgent LT and non-urgent LT in France. In univariate analysis, urgent LT was associated with an HR for death of 1.24 (95% CI 1.05 to 1.48) in the Cristal group and 1.12 (95% CI 1.05 to 1.19) in the UNOS group. In multivariate analysis, the effect of urgent LT was attenuated and no longer statistically significant in the Cristal database (HR 1.1 (95% CI 0.91 to 1.33)) while it remained constant and statistically significant in the UNOS database (HR 1.12 (95% CI 1.05 to 1.2)). Survival comparison of urgent LT patients between the two countries was significantly different in favour of the UNOS group (1-year survival rates 84.1% (80.9%–87.3%) vs 75.4% (71.8%–79.1%) and 3-year survival rates 66.3% (61.9%–71.1%) vs 62.7% (58.5%–67.1%), respectively).

Conclusion Urgent LT is associated with adverse outcome in the USA and in France with a better prognosis in the US score-based system taking post-transplant survival into account. This difference between two healthcare systems is multifactorial.

  • Lung Transplantation
  • Clinical Epidemiology
  • Critical Care

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  • X @no, @Michael_Harhay

  • Contributors AR guarantor

    AR, RP and PM conceived the idea, drafted the manuscript and analysed the data. EC and MH provided the data, contributed to data interpretation and revised the manuscript. ES, EF and RD contributed to data interpretation and revised the manuscript. P-EF, PAT, YC, FLP-B, FT, JJ, PL, JC and LB revised the manuscript. All authors have seen and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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