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The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates.

Publication ,  Journal Article
Castleberry, A; Mulvihill, MS; Yerokun, BA; Gulack, BC; Englum, B; Snyder, L; Worni, M; Osho, A; Palmer, S; Davis, RD; Hartwig, MG
Published in: J Heart Lung Transplant
July 2017

BACKGROUND: The lung allocation score (LAS) has led to improved organ allocation for transplant candidates. At present, the 6-minute walk distance (6MWD) is treated as a binary categorical variable of whether or not a candidate can walk more than 150 feet in 6 minutes. In this study, we tested the hypothesis that 6MWD is presently under-utilized with respect to discriminatory power, and that, as a continuous variable, could better prognosticate risk of waitlist mortality. METHODS: A retrospective cohort analysis was performed using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) transplant database. Candidates listed for isolated lung transplant between May 2005 and December 2011 were included. The population was stratified by 6MWD quartiles and unadjusted survival rates were estimated. Multivariable Cox proportional hazards modeling was used to assess the effect of 6MWD on risk of death. The Scientific Registry of Transplant Recipients (SRTR) Waitlist Risk Model was used to adjust for confounders. The optimal 6MWD for discriminative accuracy in predicting waitlist mortality was assessed by receiver-operating characteristic (ROC) curves. RESULTS: Analysis was performed on 12,298 recipients. Recipients were segregated into quartiles by distance walked. Waitlist mortality decreased as 6MWD increased. In the multivariable model, significant variables included 6MWD, male gender, non-white ethnicity and restrictive lung diseases. ROC curves discriminated 6-month mortality was best at 655 feet. CONCLUSIONS: The 6MWD is a significant predictor of waitlist mortality. A cut-off of 150 feet sub-optimally identifies candidates with increased risk of mortality. A cut-off between 550 and 655 feet is more optimal if 6MWD is to be treated as a dichotomous variable. Utilization of the LAS as a continuous variable could further enhance predictive capabilities.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

July 2017

Volume

36

Issue

7

Start / End Page

780 / 786

Location

United States

Related Subject Headings

  • Walking
  • Walk Test
  • Waiting Lists
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Lung Transplantation
 

Citation

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Castleberry, A., Mulvihill, M. S., Yerokun, B. A., Gulack, B. C., Englum, B., Snyder, L., … Hartwig, M. G. (2017). The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates. J Heart Lung Transplant, 36(7), 780–786. https://doi.org/10.1016/j.healun.2016.12.015
Castleberry, Anthony, Michael S. Mulvihill, Babatunde A. Yerokun, Brian C. Gulack, Brian Englum, Laurie Snyder, Mathias Worni, et al. “The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates.J Heart Lung Transplant 36, no. 7 (July 2017): 780–86. https://doi.org/10.1016/j.healun.2016.12.015.
Castleberry A, Mulvihill MS, Yerokun BA, Gulack BC, Englum B, Snyder L, et al. The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates. J Heart Lung Transplant. 2017 Jul;36(7):780–6.
Castleberry, Anthony, et al. “The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates.J Heart Lung Transplant, vol. 36, no. 7, July 2017, pp. 780–86. Pubmed, doi:10.1016/j.healun.2016.12.015.
Castleberry A, Mulvihill MS, Yerokun BA, Gulack BC, Englum B, Snyder L, Worni M, Osho A, Palmer S, Davis RD, Hartwig MG. The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates. J Heart Lung Transplant. 2017 Jul;36(7):780–786.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

July 2017

Volume

36

Issue

7

Start / End Page

780 / 786

Location

United States

Related Subject Headings

  • Walking
  • Walk Test
  • Waiting Lists
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Lung Transplantation