BACKGROUND: Increased referral for lung transplantation, persistent shortage of donor lungs, and moderate transplant outcome call not only for adequate listing criteria, but also for an optimal allocation scheme. We used global cohort survival after listing and survival benefit from transplantation to study the effect of a lung allocation scheme, primarily driven by waiting time, on the different types of end-stage lung disease. METHODS: We followed all adult patients consecutively listed for first, lung-only transplantation between 1990 and 1996 (n = 1,208) for at least 2 years, with an additional 2-year follow-up after transplantation (n = 744). We used the competing risk method, the Kaplan-Meier method, and a time-dependent non-proportional hazards model to analyze waiting-list outcome and global mortality after listing, post-transplant survival, and transplant effect, respectively. Each analysis was stratified for type of end-stage lung disease. RESULTS: At 2 years, 57% of the total cohort had received lung transplants, whereas 25% had died on the waiting list. The 2-year survival post-transplant was 55%. The global mortality of the cohort, since listing, amounted to 46% at 2 years. Compared with continued waiting, patients experienced benefit from transplantation by Day 100, which lasted until the end of the 2-year analysis period. We noticed the highest global mortality rates for patients with pulmonary fibrosis and pulmonary hypertension (54% and 52%); emphysema patients had the lowest (38%). Patients with pulmonary fibrosis and cystic fibrosis had much earlier benefit from transplantation, 55 and 90 days, respectively. Transplantation also benefited emphysema patients by Day 260. CONCLUSIONS: Lung transplantation conferred transplant benefit in a Western European cohort of adults, in particular for patients with pulmonary fibrosis and cystic fibrosis, but also for patients with emphysema. The global survival rate, reflecting the real life expectancy for a newly listed transplant candidate, is poor for patients with pulmonary fibrosis and pulmonary hypertension. Allocation algorithms that lessen the impact of waiting time and take into account the type of end-stage lung disease should be developed.
BACKGROUND: Increased referral for lung transplantation, persistent shortage of donor lungs, and moderate transplant outcome call not only for adequate listing criteria, but also for an optimal allocation scheme. We used global cohort survival after listing and survival benefit from transplantation to study the effect of a lung allocation scheme, primarily driven by waiting time, on the different types of end-stage lung disease. METHODS: We followed all adult patients consecutively listed for first, lung-only transplantation between 1990 and 1996 (n = 1,208) for at least 2 years, with an additional 2-year follow-up after transplantation (n = 744). We used the competing risk method, the Kaplan-Meier method, and a time-dependent non-proportional hazards model to analyze waiting-list outcome and global mortality after listing, post-transplant survival, and transplant effect, respectively. Each analysis was stratified for type of end-stage lung disease. RESULTS: At 2 years, 57% of the total cohort had received lung transplants, whereas 25% had died on the waiting list. The 2-year survival post-transplant was 55%. The global mortality of the cohort, since listing, amounted to 46% at 2 years. Compared with continued waiting, patients experienced benefit from transplantation by Day 100, which lasted until the end of the 2-year analysis period. We noticed the highest global mortality rates for patients with pulmonary fibrosis and pulmonary hypertension (54% and 52%); emphysemapatients had the lowest (38%). Patients with pulmonary fibrosis and cystic fibrosis had much earlier benefit from transplantation, 55 and 90 days, respectively. Transplantation also benefited emphysemapatients by Day 260. CONCLUSIONS: Lung transplantation conferred transplant benefit in a Western European cohort of adults, in particular for patients with pulmonary fibrosis and cystic fibrosis, but also for patients with emphysema. The global survival rate, reflecting the real life expectancy for a newly listed transplant candidate, is poor for patients with pulmonary fibrosis and pulmonary hypertension. Allocation algorithms that lessen the impact of waiting time and take into account the type of end-stage lung disease should be developed.
Authors: Mark J Russo; Alexander Iribarne; Kimberly N Hong; Ryan R Davies; Steve Xydas; Hiroo Takayama; Ali Ibrahimiye; Annetine C Gelijns; Matthew D Bacchetta; Frank D'Ovidio; Selim Arcasoy; Joshua R Sonett Journal: Chest Date: 2009-10-09 Impact factor: 9.410
Authors: Frederick R Adler; Paul Aurora; David H Barker; Mark L Barr; Laura S Blackwell; Otto H Bosma; Samuel Brown; D R Cox; Judy L Jensen; Geoffrey Kurland; George D Nossent; Alexandra L Quittner; Walter M Robinson; Sandy L Romero; Helen Spencer; Stuart C Sweet; Wim van der Bij; J Vermeulen; Erik A M Verschuuren; Elianne J L E Vrijlandt; William Walsh; Marlyn S Woo; Theodore G Liou Journal: Proc Am Thorac Soc Date: 2009-12
Authors: Keith M Wille; Kathy F Harrington; Joao A deAndrade; Sonia Vishin; Robert A Oster; Richard A Kaslow Journal: J Heart Lung Transplant Date: 2013-04-09 Impact factor: 10.247
Authors: Mark J Russo; Ryan R Davies; Kimberly N Hong; Alexander Iribarne; Steven Kawut; Matthew Bacchetta; Frank D'Ovidio; Selim Arcasoy; Joshua R Sonett Journal: J Thorac Cardiovasc Surg Date: 2009-11 Impact factor: 5.209
Authors: Daisy Ja Janssen; Martijn A Spruit; Joan D Does; Jos Mga Schols; Emiel Fm Wouters Journal: BMC Palliat Care Date: 2010-04-28 Impact factor: 3.234