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Determinants of the Survival Benefit of Lung Transplantation in Patients with Chronic Obstructive Pulmonary Disease

¹ Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat et Université Paris 7, Paris, France; ² INSERM U738, Paris, France; ³ Département d'Epidémiologie, de Biostatistiques et de Recherche Clinique, Hôpital Bichat et Université Paris 7, Paris, France; ⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; ⁵ Service de Chirurgie Thoracique et Vasculaire, Hôpital Bichat et Université Paris 7, Paris, France; ⁶ INSERM U717, Paris, France; and ⁷ Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis et Université Paris 7, Paris, France

Correspondence and requests for reprints should be addressed to Gabriel Thabut, M.D., Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France. E-mail: gabriel.thabut{at}bch.aphp.fr

Rationale: Although chronic obstructive pulmonary disease is the first indication for lung transplantation, the benefit of the procedure in terms of survival remains debated.

Objectives: To estimate the determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.

Methods: Using information from the United Network for Organ Sharing database on 8,182 patients, we developed an approach based on numerical simulations to estimate the survival effect of lung transplantation.

Measurements and Main Results: The main outcome measure was the difference between median survival with transplantation and that without transplantation measured from time of transplant list registration. Survival benefit was greater with double than with single lung transplantation (mean difference, 307 d [95% confidence interval, 217–523]). With double lung transplantation, 44.6% of patients would gain 1 year or more, 29.4% would gain or lose less than 1 year, and 26% would lose 1 year or more. Major determinants of the survival effect of transplantation were systolic pulmonary artery pressure, FEV₁, body mass index, exercise capacity, functional status, and the need for continuous mechanical ventilation or oxygen. For instance, 79% of patients with an FEV₁ less than 16% of the predicted value would gain 1 year or more with double lung transplantation as compared with only 11% of patients with an FEV₁ of more than 25%.

Conclusions: We identified several factors associated with the survival benefit of lung transplantation. External validation of our models is required before translating these results into clinical practice.

Key Words: lung transplantation • chronic obstructive pulmonary disease • prognosis

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The survival benefit of lung transplantation for patients with chronic obstructive pulmonary disease remains debated. What This Study Adds to the Field This study identifies the characteristics of patients who would most likely benefit from lung transplantation in terms of survival.

 

Related articles in AJRCCM:

Defining Transplantation and Listing Benefit in Patients with Chronic Obstructive Pulmonary Disease

Susan Murray and Steven Kawut
AJRCCM 2008 177: 1054-1055. [Full Text]  

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				S. Murray and S. Kawut Defining Transplantation and Listing Benefit in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., May 15, 2008; 177(10): 1054 - 1055. [Full Text] [PDF]