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

Published

Journal Article

RATIONALE: 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.

Full Text

Duke Authors

Cited Authors

  • Vock, DM; Durheim, MT; Tsuang, WM; Finlen Copeland, CA; Tsiatis, AA; Davidian, M; Neely, ML; Lederer, DJ; Palmer, SM

Published Date

  • February 2017

Published In

Volume / Issue

  • 14 / 2

Start / End Page

  • 172 - 181

PubMed ID

  • 27779905

Pubmed Central ID

  • 27779905

Electronic International Standard Serial Number (EISSN)

  • 2325-6621

Digital Object Identifier (DOI)

  • 10.1513/AnnalsATS.201606-507OC

Language

  • eng

Conference Location

  • United States