BACKGROUND: A higher predicted total lung capacity (pTLC)-ratio (=pTLC donor/pTLC recipient), suggestive of oversized allografts, is associated with improved survival after lung transplantation. It is unknown whether the pTLC-ratio has a different association with survival in bilateral (BLT) versus single lung transplantation (SLT). METHODS: The pTLC-ratio was calculated for all adult patients in the United Network of Organ Sharing lung transplant (LTx) registry who underwent first-time LTx in the post lung allocation score era, between May 2005 and April 2010. The LTx recipients were stratified according to procedure (BLT vs SLT). Risk of death at 1 year after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models. RESULTS: In the 4,520 BLT patients, each 0.1 increase in pTLC-ratio conferred a 7% decrease in the hazard for death at 1 year (p < 0.001) in univariate analysis. This association remained significant after controlling for diagnosis, comorbidities, acuity, donor, and transplant factors (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.88 to 0.98, p = 0.01). Additional adjustment by a propensity score to account for biases to oversizing showed similar results (HR 0.94, 95% CI 0.90 to 0.99, p = 0.018). In the 2,477 SLT patients, each 0.1 increase in pTLC-ratio conveyed a 6% decrease in the hazard for death at 1 year (p = 0.002) in univariate analysis, which did not persist in the multivariate model (HR 1.00, p = 0.8). CONCLUSIONS: A higher pTLC-ratio, suggestive of an oversized allograft, is associated with improved survival after lung transplantation. This association is primarily evident in BLT patients.
BACKGROUND: A higher predicted total lung capacity (pTLC)-ratio (=pTLC donor/pTLC recipient), suggestive of oversized allografts, is associated with improved survival after lung transplantation. It is unknown whether the pTLC-ratio has a different association with survival in bilateral (BLT) versus single lung transplantation (SLT). METHODS: The pTLC-ratio was calculated for all adult patients in the United Network of Organ Sharing lung transplant (LTx) registry who underwent first-time LTx in the post lung allocation score era, between May 2005 and April 2010. The LTx recipients were stratified according to procedure (BLT vs SLT). Risk of death at 1 year after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models. RESULTS: In the 4,520 BLT patients, each 0.1 increase in pTLC-ratio conferred a 7% decrease in the hazard for death at 1 year (p < 0.001) in univariate analysis. This association remained significant after controlling for diagnosis, comorbidities, acuity, donor, and transplant factors (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.88 to 0.98, p = 0.01). Additional adjustment by a propensity score to account for biases to oversizing showed similar results (HR 0.94, 95% CI 0.90 to 0.99, p = 0.018). In the 2,477 SLT patients, each 0.1 increase in pTLC-ratio conveyed a 6% decrease in the hazard for death at 1 year (p = 0.002) in univariate analysis, which did not persist in the multivariate model (HR 1.00, p = 0.8). CONCLUSIONS: A higher pTLC-ratio, suggestive of an oversized allograft, is associated with improved survival after lung transplantation. This association is primarily evident in BLT patients.
Authors: Julia Klesney-Tait; Michael Eberlein; Lois Geist; John Keech; Joseph Zabner; Peter J Gruber; Mark D Iannettoni; Kalpaj Parekh Journal: Chest Date: 2015-05 Impact factor: 9.410
Authors: Marc Hartert; Omer Senbaklavacin; Bernhard Gohrbandt; Berthold M Fischer; Roland Buhl; Christian-Friedrich Vahld Journal: Dtsch Arztebl Int Date: 2014-02-14 Impact factor: 5.594
Authors: Brian C Gulack; Michael S Mulvihill; Asvin M Ganapathi; Paul J Speicher; Godefroy Chery; Laurie D Snyder; R Duane Davis; Matthew G Hartwig Journal: Transpl Int Date: 2017-09-12 Impact factor: 3.782
Authors: Michael Eberlein; Robert M Reed; Servet Bolukbas; Joshua M Diamond; Keith M Wille; Jonathan B Orens; Roy G Brower; Jason D Christie Journal: J Heart Lung Transplant Date: 2014-09-28 Impact factor: 10.247
Authors: Asvin M Ganapathi; Michael S Mulvihill; Brian R Englum; Paul J Speicher; Brian C Gulack; Asishana A Osho; Babatunde A Yerokun; Laurie R Snyder; Duane Davis; Matthew G Hartwig Journal: Transpl Int Date: 2017-04 Impact factor: 3.782