Abstract | BACKGROUND: Increased referral for lung transplantation, persistent shortage of donor lungs, and moderate transplant outcome call not only for adequate listing criteria, but also for an optimal allocation scheme. We used global cohort survival after listing and survival benefit from transplantation to study the effect of a lung allocation scheme, primarily driven by waiting time, on the different types of end-stage lung disease. METHODS: We followed all adult patients consecutively listed for first, lung-only transplantation between 1990 and 1996 (n = 1,208) for at least 2 years, with an additional 2-year follow-up after transplantation (n = 744). We used the competing risk method, the Kaplan-Meier method, and a time-dependent non-proportional hazards model to analyze waiting-list outcome and global mortality after listing, post-transplant survival, and transplant effect, respectively. Each analysis was stratified for type of end-stage lung disease. 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-transplant was 55%. The global mortality of the cohort, since listing, amounted to 46% at 2 years. Compared with continued waiting, patients experienced benefit from transplantation by Day 100, which lasted until the end of the 2-year analysis period. We noticed the highest global mortality rates for patients with pulmonary fibrosis and pulmonary hypertension (54% and 52%); emphysema patients had the lowest (38%). Patients with pulmonary fibrosis and cystic fibrosis had much earlier benefit from transplantation, 55 and 90 days, respectively. Transplantation also benefited emphysema patients by Day 260. CONCLUSIONS:
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Authors | J De Meester, J M Smits, G G Persijn, A Haverich |
Journal | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
(J Heart Lung Transplant)
Vol. 20
Issue 5
Pg. 518-24
(May 2001)
ISSN: 1053-2498 [Print] United States |
PMID | 11343978
(Publication Type: Comparative Study, Journal Article)
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Topics |
- Adolescent
- Adult
- Cohort Studies
- Emphysema
(complications, mortality, surgery)
- Follow-Up Studies
- Humans
- Life Expectancy
- Lung Diseases
(complications, mortality, surgery)
- Lung Transplantation
(mortality)
- Pulmonary Fibrosis
(complications, mortality, surgery)
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- Waiting Lists
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