Background: We reviewed the reasons and characteristics of lung transplant recipients (LTR) referred for co-management by palliative care (PC).

Methods: This was a monocentric retrospective study including all adult LTR who were referred to our PC consultation service between 2018 and 2022 for end-of-life care.

Results:  33 patients were considered, 21 males, median age at PC referral 48 (27; 60) years old. 26 LTR were referred for terminal allograft dysfunction of any kind, whilst the rest (7) for neoplasm (see Image 1). The most frequently reported symptoms were: dyspnea (median mMRC 3 (3;4)) with oxygen desaturation on effort (29, 88%) and difficulty with everyday tasks (32, 97%); fatigue (33, 100%) and hyporexia (22, 71%) with weight loss (19, 61%); anxiety and depression (26, 81%). The vast majority of patients were prescribed specific CP medication since the first evaluation: in particular, opioids (30, 94%), pain relievers (18, 69%) and anxiolytics (17, 71%). Based on indication, CP referral for graft dysfunction tended to be earlier than for neoplasm (time from CP referral to death: respectively 17 (5; 81) days vs. 4 (1; 27), p=0.143), even if this difference was not statistically significant.  At time of first CP referral, 17 LTR were seen in the outpatient clinic; their referral proved to be significantly earlier than that of hospitalized patients (respectively, 70 (12; 141) days vs. 6 (2; 20), p=0.007). When compared to outpatient referrals, hospitalized patients were generally in more severe conditions (worse PaO2/FiO2, respiratory rate and Karnofsky score).

Conclusions: While there is still significant work to be done, our findings support integrating PC in end-of-life management of LTR.