Patient outcomes from time of listing for lung transplantation in the UK: are there disease-specific differences?

Abstract

BackgroundThe demand for lung transplantation vastly exceeds the availability of donor organs. This translates into long waiting times and high waiting list mortality. We set out to examine factors influencing patient outcomes from the time of listing for lung transplantation in the UK, examining for differences by patient characteristics, lung disease category and transplant centre.MethodsData were obtained from the UK Transplant Registry held by NHS Blood and Transplant for adult lung-only registrations between 1January 2004 and 31 March 2014. Pretransplant and post-transplant outcomes were evaluated against lung disease category, blood group and height.ResultsOf the 2213 patient registrations, COPD comprised 28.4%, pulmonary fibrosis (PF) 26.2%, cystic fibrosis (CF) 25.4% and other lung pathologies 20.1%. The chance of transplantation after listing differed by the combined effect of disease category and centre (p<0.001). At 3 years postregistration, 78% of patients with COPD were transplanted followed by 61% of patients with CF, 59% of other lung pathology patients and 48% of patients with PF, who also had the highest waiting list mortality (37%). The chance of transplantation also differed by height with taller patients having a greater chance of transplant (HR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Patients with blood group O had the highest waiting mortality at 3 years postregistration compared with all other blood groups (27% vs 20%, p<0.001).ConclusionsThe way donor lungs were allocated in the UK resulted in discrepancies between the risk profile and probability of lung transplantation. A new donor lung allocation scheme was introduced in 2017 to try to address these shortcomings.

Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines

“…Individuals with shorter stature (under 162 cm) have an increased risk of death on the lung transplant waitlist [82,83]. This disadvantage is at least partially explained by the difficulties in finding donor lungs of the correct size and is of particular importance among pediatric lung transplant candidates.…”

The therapy of idiopathic pulmonary fibrosis: what is next?

“…The challenges attributed to meeting supply with demand and having sufficient organ donation vary from country to country, thus limiting lung donor availability, and unfortunately, in some countries many IPF patients still die waiting on the lung transplant list [138][139][140]. Accordingly, the appropriate triage of IPF patients according to disease severity and setting-up priorities within the waiting list are of particular importance.…”

Cystic Fibrosis: From Qualification to Lung Transplantation, a Single Center Experience

“…Such result is slightly better than Italian study by Borchi et al who assessed that 76.08% of CF patient were able to be transplanted among all patients with known endpoints from this study [29]. Kourliouros et al reported that according to the UK Transplant Registry, only 61% of CF patients will become graft recipients 3 years after registration in the United Kingdom’s Waitlist for Lung Transplantation [30]. In our facility, 21.95% of patients with CF died on the NLTWL with 50% of patients being on it for almost 1.5 years.…”