RATIONALE: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates. OBJECTIVES: To examine the relationship between lung transplant candidate height and waiting list outcomes. METHODS: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. MEASUREMENTS AND MAIN RESULTS: The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (<162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation. CONCLUSIONS: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.
RATIONALE: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates. OBJECTIVES: To examine the relationship between lung transplant candidate height and waiting list outcomes. METHODS: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. MEASUREMENTS AND MAIN RESULTS: The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (<162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation. CONCLUSIONS:Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.
Entities:
Keywords:
body height; health services accessibility; healthcare disparity; outcome assessment
Authors: Britton C Keeshan; Joseph W Rossano; Nicole Beck; Rachel Hammond; James Kreindler; Thomas L Spray; Stephanie Fuller; Samuel Goldfarb Journal: Pediatr Transplant Date: 2014-11-19
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: C Aigner; G Winkler; P Jaksch; J Ankersmit; G Marta; S Taghavi; W Wisser; W Klepetko Journal: Transplant Proc Date: 2004-11 Impact factor: 1.066
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: Michael Eberlein; Robert M Reed; Michael Maidaa; Servet Bolukbas; George J Arnaoutakis; Jonathan B Orens; Roy G Brower; Christian A Merlo; Lawrence G Hunsicker Journal: Ann Am Thorac Soc Date: 2013-10
Authors: Ajay K Israni; Nicholas Salkowski; Sally Gustafson; Jon J Snyder; John J Friedewald; Richard N Formica; Xinyue Wang; Eugene Shteyn; Wida Cherikh; Darren Stewart; Ciara J Samana; Adrine Chung; Allyson Hart; Bertram L Kasiske Journal: J Am Soc Nephrol Date: 2014-05-15 Impact factor: 10.121
Authors: Laneshia K Tague; Chad A Witt; Derek E Byers; Roger D Yusen; Patrick R Aguilar; Hrishikesh S Kulkarni; Karen Bennett Bain; Keith A Fester; Varun Puri; Daniel Kreisel; Thalachallour Mohanakumar; Elbert P Trulock; Ramsey R Hachem Journal: Ann Am Thorac Soc Date: 2019-07
Authors: Kathleen J Ramos; Patrick J Smith; Edward F McKone; Joseph M Pilewski; Amy Lucy; Sarah E Hempstead; Erin Tallarico; Albert Faro; Daniel B Rosenbluth; Alice L Gray; Jordan M Dunitz Journal: J Cyst Fibros Date: 2019-03-27 Impact factor: 5.482
Authors: Michael S Mulvihill; Hui J Lee; Jeremy Weber; Ashley Y Choi; Morgan L Cox; Babatunde A Yerokun; Muath A Bishawi; Jacob Klapper; Maragatha Kuchibhatla; Matthew G Hartwig Journal: J Heart Lung Transplant Date: 2020-01-21 Impact factor: 10.247
Authors: Gabriel Loor; Roland Brown; Rosemary F Kelly; Kyle D Rudser; Sara J Shumway; Irena Cich; Christopher T Holley; Colleen Quinlan; Marshall I Hertz Journal: Clin Transplant Date: 2017-02-08 Impact factor: 2.863