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Establishing a new lung transplant (LTx) program requires besides a profound surgical and medical expertise, a distinct organizational and structural framework. A senior partner can provide invaluable support to avoid pitfalls related a new program. Herein, we summarize the concept and experience of the Hungarian Lung Transplantation Program in light of the Budapest-Vienna LTx cooperation. In 1996 the first Hungarian patient underwent LTx in Vienna, Austria. Subsequently, a mutual collaboration agreement was signed between the Vienna Lung Transplant Program and Hungarian professionals, thus contributing to a long-term cooperation between the two institutes. After several infrastructural developments and professional training of the medical personnel, the first LTx in Hungary was carried out at the National Institute of Oncology in collaboration with the Semmelweis University on December 12, 2015. In the next 5 years, the Hungarian Lung Transplant Program operated as part of the Vienna Lung Transplant Program. with a common waiting list and a shared donor pool. Both teams were in constant exchange and complex Hungarian recipients were either transplanted in Vienna or in Budapest with personnel support from Vienna. On September 8, 2020, our program became finally independent and was officially established within the framework of the Eurotransplant. During this 5-year cooperation, 92 and 10 LTxs for Hungarian recipients were performed in Budapest and Vienna, respectively. The one-year and three-year survival was 74,9% and 59,2 % of our patients. Importantly, within this period, our team received a structured training in re-transplantation, pediatric, multiorgan transplantation, LTxs for pulmonary hypertension and LTx after ECLS-bridging. Of note, the incidence of complications and mortality was similar to those reported by experienced centers. Altogether, this fruitful collaboration achieved consistently satisfactory results and could serve as a role model for establishing lung transplant centers elsewhere. [ABSTRACT FROM AUTHOR]

For patients, for whom the calculated LAS is not appropriately reflecting benefit of lung transplantation (LTx), a so-called exceptional LAS (eLAS) value can be requested. The aim of this study was to investigate the outcome after a first eLAS request. All patients with an eLAS request in Eurotransplant in the period between December 10, 2011 and July 31, 2019 were included (N=256). Patients were followed for at least one year until LTx or death on the waiting list (DOWL) occurred. Waiting list outflow was analyzed using competing risk method. Differences were tested using log likelihood tests. Multivariate analysis was performed to study factors determining the acceptance of an eLAS request. Of 256 patients, 97 (38%) eLAS requests were approved and 159 (62%) were declined. Within 1 year after the first request, 78 (80.4%) of the accepted patients underwent a LTx and 14 (14.4%) had died on the waiting list. In the declined group 104 (65.4%) were transplanted and 27 (17%) died on the waiting list. Patients in the approved group were significantly more likely to undergo LTX vs. the declined group (p<0.0001). No statistical difference was observed with relation to DOWL (p=0.64) (Figure) Factors significantly associated with acceptance of the eLAS request were primary diagnosis and the need for IV prostanoids (Table). No association was observed for cardiac index, ECMO, recipient age, year, and country of request. Approval of an eLAS request was associated with an increased probability of transplantation whereas decline did not result in an increased risk of death on the waiting list. [ABSTRACT FROM AUTHOR]