ArticlesEffect of diagnosis on survival benefit of lung transplantation for end-stage lung disease
Introduction
Although lung transplantation has become an invaluable approach for the treatment of end-stage respiratory disease, rates of successful outcomes are not yet as good as those for other transplanted organs. Based on data from the Joint United Network for Organ Sharing (UNOS)/International Society for Heart and Lung Transplantation (ISHLT) Thoracic Registry, 1-year mortality is more than 25% and 5-year mortality is greater than 50%.1 In addition, obliterative bronchiolitis affects more than 50% of patients late after transplantation2 and accounts for 57% of the deaths after 1 year.1
The most common indication for lung transplantation is emphysema.1 Although emphysema is debilitating, mortality from this disorder may not be as high as that from other forms of end-stage lung disease, especially in patients younger than 60 years.3, 4, 5, 6 Moreover, for some patients with emphysema, volume-reduction surgery7, 8, 9 may be an alternative. To clarify the actual survival benefit of lung transplantation for the more common causes of end-stage lung disease, including emphysema, we undertook an analysis of data from the Joint UNOS/ISHLT Thoracic Registry.
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Methods
The cohort for this study included all patients listed for transplantation with UNOS (listed for transplantation in the USA) between Jan 1, 1992, and Dec 31, 1994. The cohort included patients with the three most common indications—emphysema, cystic fibrosis, and interstitial pulmonary fibrosis.
The UNOS lung allocation scheme does not take into account disease severity; organs are allocated solely on the basis of waiting time, blood type, and body size. We included only patients undergoing
Results
Characteristics of the patients and their outcomes at the time of analysis are given in table 1. As expected, the group with cystic fibrosis was younger on average. Table 1 also gives the mean duration of follow-up in each of the clinical stages for each diagnosis. For the entire cohort, mean follow-up exceeds 18 months, with adequate follow-up for the data to be analysed over a 2-year period.
Survival while awaiting transplantation was significantly greater for patients with emphysema than for
Discussion
The data reported here support a survival benefit of lung transplantation for patients with cystic fibrosis and interstitial pulmonary fibrosis. Although there was a high mortality risk immediately after transplantation, by 1 year later survival was better than that for patients on the waiting list for both diagnoses. By contrast, for patients with emphysema, the mortality rate while they were on the waiting list was low, so post-transplantation survival did not exceed waiting-list survival
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