Clinical Transplantation. 2017;31:e13129. clinicaltransplantation.com | 1 of 8 https://doi.org/10.1111/ctr.13129 © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted: 19 September 2017 DOI: 10.1111/ctr.13129 ORIGINAL ARTICLE Single-center experience in urgent lung transplantation program in a country with a shortage of donors: Does the end justify the means? Marco Schiavon 1 | Giulio Faggi 2 | Guido Di Gregorio 3 | Francesca Calabrese 1 | Francesca Lunardi 1 | Giuseppe Marulli 1 | Paolo Feltracco 3 | Monica Loy 1 | Marco Damin 1 | Emanuele Cozzi 4 | Dario Gregori 5 | Fiorella Calabrese 1 | Federico Rea 1 1 Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy 2 Unit of Anaesthesia and Intensive Care, Padua Hospital, Padova, Italy 3 Department of Anaesthesia and Intensive Care, University of Padova, Padova, Italy 4 Transplant Immunology Unit, University of Padua, Padova, Italy 5 Department of Statistics, University of Padova, Padova, Italy Correspondence Marco Schiavon, Department of Cardio- Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padova, Padova, Italy. Email: marco.schiavon@unipd.it Abstract In rapidly deteriorating patients awaiting lung transplantation (LT), supportive strate- gies are only temporary and urgent lung transplant (ULT) remains the last option. The few publications on this topic report conflicting results. According to the Italian na- tional program, patients on mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) may be included in urgent list. We reviewed our experience from January 2012 to December 2014 with ULT and elective lung transplantation (ELT), focusing on outcomes. In the study period, 16 patients received ULT, while 51 re- ceived ELT. Among ULT, 1 patient (5.8%) died in waiting list (WL) while 16 patients underwent LT with a median WL time of 6 days. ELT WL mortality was 13.5%, and median WL time 368 days. In-hospital mortality was lower in ELT group (5.8% vs 37.5%, P < .01), while the other postoperative outcomes were not significantly differ- ent. For ULT patients, the highest impact risk factors for in-hospital mortality were pretransplant plasma transfusion, recipient Pseudomonas aeruginosa colonization, and high level of reactive C-protein and lactic acid. A ULT program with an accurate recipi- ent selection allows earlier transplantation, reducing WL mortality, with acceptable outcomes, although with a higher in-hospital mortality. Larger studies are needed to validate our results. KEYWORDS blood transfusion, lung transplantation, mortality, urgent recipient 1 | INTRODUCTION Lung transplantation (LT) has become an extensively used treat- ment for selected patients suffering from end-stage lung diseases. Only about 15% of lungs are actually retrieved from cadaveric do- nors, regardless of standard or extended criteria. Moreover, in Italy, the acceptance rate falls to 10%, with a total amount of about 120 LT per year. According to this condition, patients awaiting LT may experience worsening of their conditions, requiring supportive therapy as me- chanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO). 1,2 Whist lifesaving, these therapies can only be temporary and are associated with high waiting list mortality. For these patients, priority graft allocation appears to be the most effective strategy. In the last decade, several countries developed programs to match these patients’ needs, such as lung allocation score (LAS) system and