Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation

Singer, Lianne G.; Chowdhury, N.; Faughnan, Marie E.; Granton, John; Keshavjee, Shaf; Marras, Theodore K.; Tullis, D. Elizabeth; Waddell, Thomas K.; Tomlinson, George

doi:10.1164/rccm.201501-0126oc

Cited by 79 publications

(87 citation statements)

References 43 publications

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“…Comparison to other patients showed that the CF patients experienced fewer problems with mobility and sleep. This finding is in line with the results of previous studies regarding the influence of baseline diagnosis on HRQoL after transplantation 39, 40, 41, 42. Due to a lifetime of lung disease before LTx, the CF patients could not experience the “full” health that other groups of patients could have enjoyed in earlier stages of life.…”

Section: Discussionsupporting

confidence: 91%

Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study

Parizi

Krabbe

Verschuuren

et al. 2018

American Journal of Transplantation

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During the last three decades lung transplantation (LTx) has become a proven modality for increasing both survival and health‐related quality of life (HRQoL) in patients with various end‐stage lung diseases. Most previous studies have reported improved HRQoL shortly after LTx. With regard to long‐term effects on HRQoL, however, the evidence is less solid. This prospective cohort study was started with 828 patients who were on the waiting list for LTx. Then, in a longitudinal follow‐up, 370 post‐LTx patients were evaluated annually for up to 15 years. For all wait‐listed and follow‐up patients, the following four HRQoL instruments were administered: State‐Trait Anxiety Inventory, Zung Self‐rating Depression Scale, Nottingham Health Profile, and a visual analogue scale. Cross‐sectional and generalized estimating equation (GEE) analysis for repeated measures were performed to assess changes in HRQoL during follow‐up. After LTx, patients showed improvement in all HRQoL domains except pain, which remained steady throughout the long‐term follow‐up. The level of anxiety and depressive symptoms decreased significantly and remained constant. In conclusion, this study showed that HRQoL improves after LTx and tends to remain relatively constant for the entire life span.

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Section: Discussionsupporting

confidence: 91%

Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study

Parizi

Krabbe

Verschuuren

et al. 2018

American Journal of Transplantation

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“…(23) While subjects in both that cohort and ours experienced similar improvements in SF12-PCS defined HRQL, we observed substantially smaller improvements in EQ5D and EQVAS in absolute terms. Further, we observed that older patients had significantly less improvement in SF12 whereas the effect of increasing age on HRQL in the Canada cohort was negligible.…”

Section: Discussionsupporting

confidence: 54%

“…(9–22) Nonetheless, relatively few studies focused on HRQL itself as a primary outcome in lung transplantation have been published since the LAS overhaul. (23) Thus, given the clinical primacy of HRQL, there is a need for contemporary information on the effect of lung transplantation on general and respiratory-specific HRQL…”

Section: Introductionmentioning

confidence: 99%

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Singer

Katz

Soong

et al. 2017

American Journal of Transplantation

100

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Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study, from 2010–2016 we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-minute walk test exercise capacity as predictors of HRQL change. Amongst 211 initial participants (92% of those eligible), LT improved HRQL by all five measures (p<0.05) and all but SF12-Mental Health improved by three-fold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p<0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net-benefits of LT.

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“…Second, our analysis focuses on the survival benefit of transplantation; it does not address other important outcomes such as quality of life (QOL), improvements in which have been demonstrated in previous analyses of lung transplantation (42)(43)(44)(45)(46)(47)(48). Other end points including composite end points of survival, QOL, and cost could change our interpretation of the relative benefit of transplantation.…”

Section: Limitationsmentioning

confidence: 99%

Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation

et al. 2017

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ORCID IDs: 0000-0002-5459-9579 (D.M.V.); 0000-0002-4186-5698 (M.T.D.). AbstractRationale: Lung transplantation is an accepted and increasingly employed treatment for advanced lung diseases, but the anticipated survival benefit of lung transplantation is poorly understood.Objectives: To determine whether and for which patients lung transplantation confers a survival benefit in the modern era of U.S. lung allocation.Methods: Data on 13,040 adults listed for lung transplantation between May 2005 and September 2011 were obtained from the United Network for Organ Sharing. A structural nested accelerated failure time model was used to model the survival benefit of lung transplantation over time. The effects of patient, donor, and transplant center characteristics on the relative survival benefit of transplantation were examined.Measurements and Main Results: Overall, 73.8% of transplant recipients were predicted to achieve a 2-year survival benefit with lung transplantation. The survival benefit of transplantation varied by native disease group (P = 0.062), with 2-year expected benefit in 39.2 and 98.9% of transplants occurring in those with obstructive lung disease and cystic fibrosis, respectively, and by lung allocation score at the time of transplantation (P , 0.001), with net 2-year benefit in only 6.8% of transplants occurring for lung allocation score less than 32.5 and in 99.9% of transplants for lung allocation score exceeding 40.Conclusions: A majority of adults undergoing transplantation experience a survival benefit, with the greatest potential benefit in those with higher lung allocation scores or restrictive native lung disease or cystic fibrosis. These results provide novel information to assess the expected benefit of lung transplantation at an individual level and to enhance lung allocation policy.

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Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation

Abstract: Lung transplantation confers large HRQL benefits, which vary by recipient diagnosis, but do not differ substantially in older recipients.

Cited by 79 publications

References 43 publications

Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study

Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study

Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation

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