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
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.