Listing for lung transplantation: Life expectancy and transplant effect, stratified by type of end-stage lung disease, the eurotransplant experience

Citation
J. De Meester et al., Listing for lung transplantation: Life expectancy and transplant effect, stratified by type of end-stage lung disease, the eurotransplant experience, J HEART LUN, 20(5), 2001, pp. 518-524
Citations number
18
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN journal
10532498 → ACNP
Volume
20
Issue
5
Year of publication
2001
Pages
518 - 524
Database
ISI
SICI code
1053-2498(200105)20:5<518:LFLTLE>2.0.ZU;2-H
Abstract
Background: Increased referral for lung transplantation, persistent shortag e of donor lungs, and moderate transplant outcome call not only for adequat e listing criteria, but also for an optimal allocation scheme. We used glob al cohort survival after listing and survival benefit from transplantation to study the effect of a lung allocation scheme, primarily driven by waitin g time, on the different types of end-stage lung disease. Methods: We followed all adult patients consecutively listed for first, lun g-only transplantation between 1990 and 1996 (n = 1,208) for at least 2 yea rs, with an additional 2-year follow-up after transplantation (n = 744). We used the competing risk method, the Kaplan-Meier method, and a time-depend ent non-proportional hazards model to analyze waiting-list outcome and glob al mortality after listing, post-transplant survival, and transplant effect , respectively. Each analysis was stratified for type of end-stage lung dis ease. 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-transpl ant was 55%. The global mortality of the cohort, since listing, amounted to 46% at 2 years. Compared with continued waiting, patients experienced bene fit from transplantation by Day 100, which lasted until the end of the 2-ye ar analysis period. We noticed the highest global mortality rates for patie nts with pulmonary fibrosis and pulmonary hypertension (54% and 52%); emphy sema patients had the lowest (38%). Patients with pulmonary fibrosis and cy stic fibrosis had much earlier benefit from transplantation, 55 and 90 days , respectively. Transplantation also benefited emphysema patients by Day 26 0. Conclusions: Lung transplantation conferred transplant benefit in a Western European cohort of adults, in particular for patients with pulmonary fibro sis and cystic fibrosis, but also for patients with emphysema. The global s urvival rate, reflecting the real life expectancy for a newly listed transp lant 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 develope d.