Outcomes of urgent lung transplantation in critically ill patients versus standard lung transplantation: A systematic review and meta-analysis

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews Pub Date : 2025-04-23 DOI:10.1016/j.trre.2025.100933

Xiaohan Jin , Haoji Yan , Zengwei Yu , Jier Ma , Xiangyun Zheng , Weiyang Chen , Yaling Liu , Jiaze Li , Qiang Pu , Dong Tian

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Abstract

Background

Whether survival differs between urgent lung transplantation (ULTx) and standard lung transplantation (LTx) remains unclear. This systematic review and meta-analysis aimed to evaluate survival and other post-transplant outcomes between ULTx and standard LTx.

Methods

PubMed, Embase, and Cochrane Library were searched up to July 31, 2024 for relevant studies. A meta-analysis of baseline characteristics and postoperative outcomes was then performed, with subgroup analyses by study designs and indications. Overall survival (OS) was set as the primary outcome in this study. Risk ratio (RR), mean differences (MD) with 95 % confidence interval (CI) were assessed using fixed-effects or random-effects models.

Results

Nine studies with 934 ULTx and 2980 standard LTx patients were included. ULTx group exhibited lower donor PaO₂/FiO₂ (P = 0.03) and higher pre-operative life support use (P < 0.001) than standard LTx group. No statistical difference in waiting list mortality was found between groups (28.4 % vs. 12.6 %; P = 0.54). ULTx was associated with significantly lower 1-year, 3-year, and 5-year OS than standard LTx (70.2 % vs. 80.0 %, 57.7 % vs. 66.7 %, 46.5 % vs. 56.2 %; all P < 0.001). At each time point, about 10 % OS rate differences were found consistently. In most subgroups, ULTx was associated with worse outcomes, but no difference in OS was observed in cystic fibrosis (CF) patients.

Conclusions

ULTx reduces waiting list mortality in critical patients, but is associated with worse OS than standard LTx. ULTx may limit short-term survival rather than long-term survival compared with standard LTx.

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危重患者紧急肺移植与标准肺移植的结果：系统回顾和荟萃分析

背景急诊肺移植（ULTx）和标准肺移植（LTx）的存活率是否不同仍不清楚。本系统综述和荟萃分析旨在评估ULTx和标准LTx的存活率及其他移植后结果。方法检索了PubMed、Embase和Cochrane图书馆截至2024年7月31日的相关研究。然后对基线特征和术后结果进行了荟萃分析，并根据研究设计和适应症进行了亚组分析。本研究将总生存期（OS）作为主要结果。采用固定效应或随机效应模型评估了风险比（RR）、平均差异（MD）及 95% 置信区间（CI）。与标准 LTx 组相比，ULTx 组的供体 PaO2/FiO2 更低（P = 0.03），术前生命支持使用率更高（P < 0.001）。两组之间的候诊死亡率无统计学差异（28.4% vs. 12.6%；P = 0.54）。ULTx的1年、3年和5年OS明显低于标准LTx（70.2% vs. 80.0%、57.7% vs. 66.7%、46.5% vs. 56.2%；所有P均为0.001）。在每个时间点，OS率差异均在10%左右。在大多数亚组中，ULTx与较差的预后相关，但在囊性纤维化（CF）患者中未观察到OS差异。与标准LTx相比，ULTx可能会限制短期生存而非长期生存。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.