Lung Transplantation for Patients with a High-Risk Profile.

Selection of transplant recipients remains one of the major challenges in lung transplantation (LTx). Based on the most recent ISHLT consensus statement, the terms 'absolute' and 'relative' contraindications for LTx were replaced by a system of 'risk factors'. Searching the literature, there is, however, only very limited evidence supporting this concept. The aim of this study was to evaluate the benefit of LTx for patients with a risk profile according to the ISHLT definition. In this retrospective cohort study patients with fibrosis, COPD or cystic fibrosis undergoing primary bilateral lung transplantation between 2015 and 2020 were included (n=479). Comorbidities were assessed at time of listing, and scored as high (1 point) or moderate (0.5 points) risk factors according to the latest ISHLT consensus statement. The study cohort was categorized into three groups based on their scores (score 0/1-2/greater than 2). Posttransplant survival probabilities at 3, 12 and 60 months were compared between the groups with Kaplan-Meier survival analysis and log-rank tests. 479 patients (272 males) were included in the study with a median age of 56 years. 133 (27.8%) patients had no relevant comorbidities, 281 (58.7%) scored between 1-2, and 65 (13.6%) had 2 and more risk factors. In Kaplan-Meier analysis there were no significant differences in survival after 3 months (p=0.407), 12 (p=0.551) or 60 months (p=0.457) between the three groups. In uni- and multivariate analysis, only chest wall deformity was a prognostic parameter for impaired survival after the first year after LTx. LTx for well-selected recipients with substantial comorbidities is safe and associated with similar short- and long-term survival, if performed at experienced transplant centers. In the light of limited organ availability, careful recipient selection remains an ethical and medical challenge and should take an individualized risk-benefit assessment into account. [ABSTRACT FROM AUTHOR]