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Understanding lung transplant listing practices: Survival in lung transplant candidates who improve clinically to delisting.

Abstract：

BACKGROUND:Occasionally, lung transplant candidates improve to the point where they are removed from the transplant list. We sought to determine the characteristics and outcomes of lung transplant candidates who improved to delisting both before and after implementation of the lung allocation score. METHODS:Using the United Network for Organ Sharing database, we reviewed all adult patients listed for lung transplant between 1987 and 2012. The last permanent status change was classified into transplanted, improved to delisting (improved), or deteriorated to delisting (deteriorated). Survival time was calculated using the linked date of death from the Social Security Administration. Survival analysis was performed via the Kaplan-Meier method, and adjusted multivariable logistic regressions identified characteristics predicting improvement to delisting. RESULTS:Of 13,688 candidates, 12,188 (89.0%) were transplanted, 454 (3.3%) improved, and 1,046 (7.6%) deteriorated. The 5-year mortality was greater in improved (hazard ratio = 1.21 [1.07-1.38], P = .002) and deteriorated (hazard ratio = 3.36 [3.11-3.64], P < .001) candidates relative to those transplanted; however, 1-year survival was greater in improved versus transplanted candidates (75.9% vs 67.2%, log rank P < .001). Older, female patients listed for primary pulmonary hypertension and retransplantation were more likely to improve to delisting. The proportion of improved patients varied by hospital quartile volume (P < .001) and the United Network for Organ Sharing geographic region (P < .001). The number of patients improving to delisting decreased after implementation of the lung allocation score. CONCLUSION:Lung transplant candidates improving to delisting faced less short-term but greater long-term mortality relative to transplanted candidates. Given that the improved population decreased dramatically after implementation of the lung allocation score, redefining patient listing criteria appears to have improved patient appropriateness for transplant.

journal_name

Surgery

journal_title

Surgery

authors

Rudasill SE,Sanaiha Y,Kwon M,Mardock AL,Khoury H,Omari B,Rabkin DG,Benharash P

doi

10.1016/j.surg.2019.07.009

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1142-1147

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(19)30457-X

journal_volume

166

pub_type

杂志文章

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Understanding lung transplant listing practices: Survival in lung transplant candidates who improve clinically to delisting.