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. 2023 Jul 17;9(4):00738-2022.
doi: 10.1183/23120541.00738-2022. eCollection 2023 Jul.

Sarcoidosis lung transplantation waitlist mortality, a national registry database study

Derlis C Fleitas Sosa  1   2 , Shameek Gayen  1   2 , Matthew Zheng  3 , Andrew J Gangemi  1 , Huaqing Zhao  4 , Victor Kim  1 , Sameep Sehgal  5 , Gerard J Criner  1 , Rohit Gupta  1 , A James Mamary  1
Affiliations

Sarcoidosis lung transplantation waitlist mortality, a national registry database study

Derlis C Fleitas Sosa et al. ERJ Open Res. .

Abstract

Background: The Lung Allocation Score (LAS) prioritises lung transplantation candidates, balancing waitlist mortality and post-transplant survival. The score groups sarcoidosis candidates based on mean pulmonary artery pressure: those with ≤30 mmHg (sarcoidosis A) are grouped with COPD and those with >30 mmHg (sarcoidosis D) with idiopathic pulmonary fibrosis (IPF). We hypothesise that sarcoidosis candidates have a higher waitlist mortality than other candidates within their LAS grouping.

Methods: This is a retrospective cohort study of consecutive lung transplantation candidates from the Scientific Registry of Transplant Recipients database from May 2005 to May 2019. We included candidates aged ≥18 years diagnosed with sarcoidosis, COPD or IPF. Univariate, multivariate and survival estimate analyses were performed.

Results: We identified 385 sarcoidosis A, 642 sarcoidosis D, 7081 COPD and 10 639 IPF lung transplantation candidates. 17.3% of sarcoidosis D, 14.8% of IPF, 14.3% of sarcoidosis A and 9.8% of COPD candidates died awaiting transplant. Sarcoidosis A was an independent risk factor for waitlist mortality. Sarcoidosis A had a lower waitlist survival probability compared to COPD. Sarcoidosis D had the highest waitlist mortality. IPF candidates had lower waitlist survival probability than sarcoidosis D in the first 60 days after listing.

Conclusion: Based on our results, the grouping of candidates with sarcoidosis in allocation systems should be revised to mitigate waitlist mortality disparity.

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Conflict of interest statement

Conflicts of interest: The authors of this manuscript have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Waitlist removal reasons by diagnosis per month in the first year after listing, expressed as percentages. a) COPD; b) sarcoidosis A; c) idiopathic pulmonary fibrosis (IPF); and d) sarcoidosis D.
FIGURE 2
FIGURE 2
Comparison of the survival probability in the first year after listing of sarcoidosis A and COPD.
FIGURE 3
FIGURE 3
Hazard ratios (95% confidence limits) of statistically significant variables of the multivariable analysis comparing sarcoidosis A and COPD. Statistically nonsignificant variables considered in the multivariable analysis were race, body mass index, diabetes, functional status, cardiac output, lung preference, height and creatinine. mPAP: mean pulmonary artery pressure; PCO2: carbon dioxide tension; 6MWD: 6-min walk distance.
FIGURE 4
FIGURE 4
Comparison of the survival probability in the first year after listing of sarcoidosis D and idiopathic pulmonary fibrosis (IPF).
See this image and copyright information in PMC

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: 1212–1227. doi:10.1111/j.1600-6143.2006.01276.x - DOI - PubMed
    1. Kozower BD, Meyers BF, Smith MA, et al. . The impact of the lung allocation score on short-term transplantation outcomes: a multicenter study. J Thorac Cardiovasc Surg 2008; 135: 166–171. doi:10.1016/j.jtcvs.2007.08.044 - DOI - PubMed
    1. Cheronis N, Rabold E, Singh A, et al. . Lung transplantation in COPD. Crit Care Nurs Q 2021; 44: 61–73. doi:10.1097/CNQ.0000000000000340 - DOI - PubMed
    1. Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 2016; 35: 433–439. doi:10.1016/j.healun.2016.01.010 - DOI - PubMed
    1. Chen H, Shiboski SC, Golden JA, et al. . Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension. Am J Respir Crit Care Med 2009; 180: 468–474. doi:10.1164/rccm.200810-1603OC - DOI - PMC - PubMed

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