International Collaboration Agreement: the Impact of A New Lung Allocation Policy on Post Transplant Outcomes in Argentina and Uruguay

The lung allocations policies develop by each country should be oriented to assure the accessibility and to improve post lung transplant (LT) outcomes. Since 2003, within an international collaboration agreement, all LT recipients from Uruguay were transplanted at a single centre in Argentina. In December 2010, a new lung allocation policy (LAP) was established to meet these goals in Argentina and Uruguay. The purpose was to compare early post LT outcomes according to the change in the LAP in Argentina and Uruguay. We retrospectively analyzed records of LT recipients from Argentina and Uruguay transplanted at a single centre, between January 1994 and June 2014. Patients were divided into two groups, according to the in force LAP at the moment of the LT procedure. Group 1 (G1) included all LT recipients between 1994 and 2010 and Group 2 (G2) between 2011 and 2014. Survival was analyzed by Kaplan Meier curves and compared by Log Rank Test between groups. The study included 267 LT (143 SLT and 124 BLT) performed to 258 recipients. G1:185 LT (69%) and G2:82 LT (31%). The percentage of SLT/BLT (G1 vs G2) was 62%/38% vs 35%/65% (p<0.001) respectively. Clinical status at LT was: Emergency 14% vs 54%; Urgency 16% vs 28% and Elective 70% vs 18%;(p<0.001). The use of CPB during LT was 30% vs 50% (p=0.003) and Ischemic Time was 300±86 min vs 340±66 min (p=0.001). In-hospital mortality was 24% vs 11% (p=0.01). Comparative survival at 1 and 2 years was 64% and 54% vs 87% and 87%; (p<0.001)(Figure 1). A significant increase in the number of emergency LT, longer ischemic times and greater necessity of CPB for implantation was observed with the implementation of the new lung allocation policy. Nonetheless, the in-hospital mortality was significantly lower, and the 1 and 2 years survival showed a significant improvement. These results support in part the new strategy for lung allocation in Argentina and Uruguay.