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. 2012 Nov;31(11):1182-91.
doi: 10.1016/j.healun.2012.07.001. Epub 2012 Aug 11.

Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

Timothy J George  1 , Claude A Beaty, Arman Kilic, Pali D Shah, Christian A Merlo, Ashish S Shah
Affiliations

Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

Timothy J George et al. J Heart Lung Transplant. 2012 Nov.

Abstract

Introduction: Although several studies have evaluated risk factors for death after lung transplantation (LTx), few studies have focused on the highest-risk recipients. We undertook this study to evaluate the effect of high lung allocation scores (LAS), ventilator support, and extracorporeal membrane oxygenation (ECMO) support on outcomes after LTx.

Methods: We retrospectively reviewed all LTx recipients in the United Network for Organ Sharing database. Primary stratification was by recipient acuity at the time of LTx. The 3 strata consisted of (1) recipients in the highest LAS quartile (LAS ≥ 48.4), (2) those requiring ventilator support, and (3) those requiring ECMO support. The primary outcome was 1-year mortality. Sub-group analysis focused on temporal trends.

Results: From May 2005 to June 2011, 9,267 adults underwent LTx. Before LTx, 1,874 (20.2%) were in the highest LAS quartile, 526 (5.7%) required ventilator support, and 122 (1.3%) required ECMO support. Unadjusted analysis showed decreased 1-year survival associated with ventilator (67.7%) and ECMO support (57.6%) compared with the highest LAS quartile (81.0%; p < 0.001 for each comparison). These differences persisted on adjusted analysis for ventilator support (hazard ratio, 1.99, p < 0.001) and ECMO support (hazard ratio, 3.03; p < 0.001). Increasing annual center volume was associated with decreased mortality. In patients bridged to LTx with ECMO support, 1-year survival improved over time (coefficient, 8.03% per year; p = 0.06).

Conclusions: High-acuity LTx recipients, particularly those bridged with ventilator or ECMO support, have increased short-term mortality after LTx. However, since the introduction of the LAS, high-risk patients have demonstrated improving outcomes, particularly at high-volume centers.

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Figures

Figure 1
Figure 1
Bar graph depicting the number of annual lung transplants in the United States. Each bar represents the total lung transplants in a given year. Patients bridged to lung transplantation with ECMO support are depicted with checkered bars, patients bridged to lung transplantation with a ventilator are depicted with striped bars, and all other patients are depicted with solid black bars. Numbers for the year 2011 represent all lung transplants through June.
Figure 2
Figure 2
(A) 2-year Kaplan-Meier survival curves stratified by recipient acuity. (B) 2-year Kaplan-Meier survival curves conditional on 90-day survival stratified by recipient acuity. Recipients in the highest LAS quartile are depicted with a solid line, those requiring ventilatory support with a dashed line, and those requiring ECMO support with a dash-dot line. P-values were determined by the log-rank test.
Figure 2
Figure 2
(A) 2-year Kaplan-Meier survival curves stratified by recipient acuity. (B) 2-year Kaplan-Meier survival curves conditional on 90-day survival stratified by recipient acuity. Recipients in the highest LAS quartile are depicted with a solid line, those requiring ventilatory support with a dashed line, and those requiring ECMO support with a dash-dot line. P-values were determined by the log-rank test.
Figure 3
Figure 3
Bar graphs of 1-year survival stratified by year for (A) recipients in the highest LAS quartile, (B) recipients requiring ventilatory support, and (C) recipients requiring ECMO support. Survival was determined by the Kaplan-Meier method. Error bars denote standard error. Solid line represents the line of best fit. P-values were determined by linear regression.
Figure 3
Figure 3
Bar graphs of 1-year survival stratified by year for (A) recipients in the highest LAS quartile, (B) recipients requiring ventilatory support, and (C) recipients requiring ECMO support. Survival was determined by the Kaplan-Meier method. Error bars denote standard error. Solid line represents the line of best fit. P-values were determined by linear regression.
Figure 3
Figure 3
Bar graphs of 1-year survival stratified by year for (A) recipients in the highest LAS quartile, (B) recipients requiring ventilatory support, and (C) recipients requiring ECMO support. Survival was determined by the Kaplan-Meier method. Error bars denote standard error. Solid line represents the line of best fit. P-values were determined by linear regression.
Figure 4
Figure 4
Kaplan-Meier curves of 1-year survival stratified by (A) diagnosis, (B) annual center volume strata, and (F) type of lung transplant. P-value determined by the log-rank test. Abbreviations: LTx, lung transplantation; SLT, single lung transplant; BLT, bilateral lung transplant.
Figure 4
Figure 4
Kaplan-Meier curves of 1-year survival stratified by (A) diagnosis, (B) annual center volume strata, and (F) type of lung transplant. P-value determined by the log-rank test. Abbreviations: LTx, lung transplantation; SLT, single lung transplant; BLT, bilateral lung transplant.
Figure 4
Figure 4
Kaplan-Meier curves of 1-year survival stratified by (A) diagnosis, (B) annual center volume strata, and (F) type of lung transplant. P-value determined by the log-rank test. Abbreviations: LTx, lung transplantation; SLT, single lung transplant; BLT, bilateral lung transplant.
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References

    1. Egan TM, Murray S, Bustami RT, et al. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6(5):1212–27. Pt 2. - PubMed
    1. Mason DP, Thuita L, Nowicki ER, et al. Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg. 2010;139(3):765–73. e1. - PubMed
    1. Bermudez CA, Rocha RV, Zaldonis D, et al. Extracorporeal membrane oxygenation as a bridge to lung transplant: midterm outcomes. Ann Thorac Surg. 2011;92(4):1226–31. discussion 31-2. - PubMed
    1. Vermeijden JW, Zijlstra JG, Erasmus ME, van der Bij W, Verschuuren EA. Lung transplantation for ventilator-dependent respiratory failure. J Heart Lung Transplant. 2009;28(4):347–51. - PubMed
    1. Bartz RR, Love RB, Leverson GE, et al. Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis. J Heart Lung Transplant. 2003;22(4):433–8. - PubMed

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