Lung Transplantation in Patients With Chronic Obstructive Pulmonary Disease in a National Cohort Is Without Obvious Survival Benefit

Stavem, Knut; Bjørtuft, Øystein; Borgan, Ørnulf; Geiran, Odd; J, Bøe

doi:10.1016/j.healun.2005.06.025

Cited by 75 publications

(55 citation statements)

References 40 publications

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“…Therefore, a slight majority of patients with obstructive lung disease do not experience an expected survival benefit at 2 years. Variability in the average patient acuity in previous study cohorts, typically drawn from only a single or small number of centers, may explain some of the discrepancy between prior studies (4,5,8,13,14,18).…”

Section: Discussionmentioning

confidence: 94%

“…We assumed that the log acceleration factor was linearly related to current LAS, LAS squared, native disease grouping, center volume over the preceding 2 years, recipient age, donor age greater than 55 years, donor smoking status, and difference in height greater than 0 between recipient and donor (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(32)(33)(34)(35). That is, these factors may moderate the effect of transplantation and increase or decrease the relative survival benefit on the multiplicative scale.…”

Section: Methodsmentioning

confidence: 99%

“…However, transplantation may incur a survival loss shortly after transplantation due to peri-and early postoperative complications but confer a survival benefit in the longer term (5,10,13,17). As described in the online supplement, to address this possibility, we allowed the acceleration factor to change at 180, 365, and 730 days posttransplantation, which allows for a different early and longterm relative survival benefit.…”

Section: Methodsmentioning

confidence: 99%

“…Single-center and registrybased studies (e.g., United Network for Organ Sharing [UNOS], Eurotransplant, and UK national registries) have arrived at varying and sometimes inconsistent conclusions on the efficacy of lung transplantation in adults (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These studies are subject to several limitations.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2017

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“…NETT also found that the wide use of LVRS was limited in clinical contexts because of the physical condition the patient had to be in, surgical trauma, a postoperative mortality rate of up to 7.9% in the next 90 days, an incidence of pulmonary complications as high as 29.8%, and an incidence of cardiovascular complications as high as 20.8%. Whether lung transplantation may improve lung function, pulmonary activity, quality of life, and longterm survival for patients with emphysema appears inconclusive, and such an option cannot be widely promoted due to the vast shortage of donors, surgical trauma, major problems after transplant rejection, and infection (8,9). Therefore, surgery has limited ability to meet clinical needs, and a new, minimally invasive, and effective treatment is needed to eliminate the bottleneck limiting current techniques and approaches.…”

Section: Discussionmentioning

confidence: 99%