DOES LUNG TRANSPLANTATION PROLONG LIFE - A COMPARISON OF SURVIVAL WITH AND WITHOUT TRANSPLANTATION

Background: Because of the assumed beneficial effect of lung transplan tation on survival, controlled trials to assess the therapeutic benefi t of lung transplantation are considered to be unethical. Therefore ot her methods must be used to provide control data. In this study the ef fect of lung transplantation on survival for patients with end-stage p ulmonary disease was analyzed, with waiting list survival rates used a s control data. Methods: The analysis was based on 157 consecutive pat ients who were put on the waiting list of the Dutch lung transplantati on program during the period November 1990 to January 31, 1996, of who m 76 underwent transplantation. Following the principles of control gr oup estimation as set out in the context of heart transplantation, a s tepwise approach was used to arrive at a multivariate time-dependent C ox regression model. The following prognostic variables were included in the analyses: age, forced expiratory volume in 1 second, partial pr essure of carbon dioxide, partial pressure of oxygen, and diagnosis. R esults: The 1- and 2-year waiting list survival rates were 78% and 58% , respectively. The 1- and 2-year transplantation survival rates (i.e. , survival from placement on the waiting list, including posttransplan tation survival) were 79% and 64%, respectively. The multivariate time -dependent Cox analysis showed that lung transplantation reduced the r isk of dying by 55% (95% confidence interval, 3% to 79%). For patients with emphysema the risk of dying was estimated to be 77% lower than f or patients with other diagnoses (96% confidence interval, 50% to 89%) . Conclusions: With COX regression, adjusting for age, forced expirato ry volume in 1 second, partial pressure of carbon dioxide, partial pre ssure of oxygen, and diagnosis, lung transplantation showed a statisti cally significant effect on survival in selected patients with end-sta ge pulmonary disease.