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Boateng S, Ameyaw P, Gyabaah S, Adjepong Y, Njei B. Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults. World J Transplant 2024; 14:93561. [PMID: 39295973 PMCID: PMC11317861 DOI: 10.5500/wjt.v14.i3.93561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/27/2024] [Accepted: 06/13/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking. AIM To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults. METHODS We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. RESULTS The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23-1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24-2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes. CONCLUSION Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.
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Affiliation(s)
- Sarpong Boateng
- Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, United States
- Department of Epidemiology and Biostatistics, University of North Texas, Fort Worth, TX 76107, United States
| | - Prince Ameyaw
- Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Solomon Gyabaah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi KS 1934, Ghana
| | - Yaw Adjepong
- Yale University School of Medicine, New Haven, CT 06520, United States
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
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Seijo L, Gao Y, Betancourt L, Venado A, Hays SR, Kukreja J, Calabrese DR, Greenland JR, Singer JP. Improvements in Patient-Reported Functioning after Lung Transplant is Associated with Improved Quality of Life and Survival. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.05.24311510. [PMID: 39211845 PMCID: PMC11361250 DOI: 10.1101/2024.08.05.24311510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Lung transplantation aims to improve health-related quality of life (HRQL) and survival. While lung function improvements are associated with these outcomes, the association between physical functioning and these outcomes is less clear. We investigated the association between changes in patient-reported physical functioning and HRQL, chronic lung allograft dysfunction (CLAD), and survival after lung transplantation. This single-center prospective cohort study analyzed 220 lung transplant recipients who completed the 15-item Lung Transplant Valued Life Activities (LT-VLA) before and repeatedly after transplant. HRQL was assessed using generic, respiratory disease-specific, and utility measures. Associations between 0.3-point changes (the minimally important difference) in LT-VLA as a time-varying predictor on HRQL, CLAD, and mortality were tested using linear regression and Cox proportional hazard models. Models were adjusted for demographics, disease diagnosis, and post-operative lung function as a time-varying covariate. Participants were 45% female and 75% White, with a mean age of 56 (±12) years. Each 0.3-point improvement in LT-VLA was associated with substantially improved HRQL across all measures (adjusted p-values <0.01). Each 0.3-point improvement in LT-VLA was associated with a 13% reduced hazard of CLAD (adjusted HR: 0.87, 95% CI: 0.76-0.99, p=0.03) and a 19% reduced hazard of mortality (adjusted HR: 0.81, 95% CI: 0.67-0.95, p=0.01). Improvements in patient-reported physical functioning after lung transplantation are associated with improved HRQL and reduced risk of CLAD and death, independent of allograft function. The simplicity of the LT-VLA suggests it could be a valuable monitoring or outcome measure in both clinical and research settings.
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Rathi V, Tiwari P, Seth S, Hadda V, Madan K, Agarwal S, Vij A, Hote M, Sahu M, Mittal S, Guleria R, Pandey S, Pandey RM, Mohan A. Profile of patients referred for lung transplant and their transplant-free survival. Lung India 2024; 41:265-271. [PMID: 38953189 PMCID: PMC11302780 DOI: 10.4103/lungindia.lungindia_515_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Lung transplant (LTx) is a potential treatment option for all patients with chronic, end-stage respiratory disease, who are refractory to optimal medical therapy or where no medical therapy exists. In India, LTx is still in its evolving stages and published literature is sparse. The current study was carried out to study the selection criteria for lung transplant and to evaluate the clinical and socio-economic profile of patients referred for the same at a tertiary health care facility. METHODS The study was a descriptive, prospective, observational study. All adults referred for lung transplant were evaluated for clinical and laboratory profiles. All enrolled patients were assessed for presence of referral criteria, listing criteria, contraindications, and willingness for lung transplant. These patients were followed up for 2 years for transplant-free survival, and the Cox proportional hazards model was used to determine independent predictors of all-cause mortality. RESULTS A total of 103 were included in study. The most common diagnosis was interstitial lung disease (57.2%), followed by bronchiectasis (17.5%) and COPD (13.6%). Most patients were referred for LTx at an advanced stage as 90% met listing criteria. Fifty-four (52.4%) patients had an absolute or relative contraindication to transplant; however, the majority of those contraindications were modifiable. Patients with a lower socio-economic status were less likely to be willing for LTx. The median survival was 757 days. A 6-minute walk distance (6MWD) lesser than 250 m was found to be an independent predictor of mortality. CONCLUSION Making patients aware about lung transplant early in their treatment may give them sufficient time to come to terms with their disease and understand the risk and benefits associated. Efforts should be focused on screening and early treatment of reversible contraindications for the eligible patients. Patients with 6MWD < 250 m are at increased risk of mortality.
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Affiliation(s)
- Vidushi Rathi
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, AIIMS, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Shubham Agarwal
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Arti Vij
- Organ Retrieval and Banking Organization, AIIMS, New Delhi, India
| | | | - Manoj Sahu
- Department of CTVS, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, AIIMS, New Delhi, India
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, AIIMS, New Delhi, India
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Kent J, Nordgren R, Ahn D, Lysandrou M, Diaz A, Fenton D, Wignakumar T, McMeekin N, Salerno C, Donington J, Madariaga MLL. Cost effectiveness of commercial portable ex vivo lung perfusion at a low-volume US lung transplant center. Artif Organs 2024. [PMID: 38924545 DOI: 10.1111/aor.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Portable ex vivo lung perfusion during lung transplantation is a resource-intensive technology. In light of its increasing use, we evaluated the cost-effectiveness of ex vivo lung perfusion at a low-volume lung transplant center in the USA. METHODS Patients listed for lung transplantation (2015-2021) in the United Network for Organ Sharing database were included. Quality-of-life was approximated by Karnofsky Performance Status scores 1-year post-transplant. Total transplantation encounter and 1-year follow-up costs accrued by our academic center for patients listed from 2018 to 2021 were obtained. Cost-effectiveness was calculated by evaluating the number of patients attaining various Karnofsky scores relative to cost. RESULTS Of the 13 930 adult patients who underwent lung transplant in the United Network for Organ Sharing database, 13 477 (96.7%) used static cold storage and 453 (3.3%) used ex vivo lung perfusion, compared to 30/58 (51.7%) and 28/58 (48.3%), respectively, at our center. Compared to static cold storage, median total costs at 1 year were higher for ex vivo lung perfusion ($918 000 vs. $516 000; p = 0.007) along with the cost of living 1 year with a Karnofsky functional status of 100 after transplant ($1 290 000 vs. $841 000). In simulated scenarios, each Karnofsky-adjusted life year gained by ex vivo lung perfusion was 1.00-1.72 times more expensive. CONCLUSIONS Portable ex vivo lung perfusion is not currently cost-effective at a low-volume transplant centers in the USA, being 1.53 times more expensive per Karnofsky-adjusted life year. Improving donor lung and/or recipient biology during ex vivo lung perfusion may improve its utility for routine transplantation.
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Affiliation(s)
- Johnathan Kent
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Daniel Ahn
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Maria Lysandrou
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Nicola McMeekin
- Glasgow Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher Salerno
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jessica Donington
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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Deitz RL, Clifford S, Ryan JP, Chan EG, Coster JN, Furukawa M, Hage CA, Sanchez PG. Performance status at the time of lung retransplant predicts long-term function. Clin Transplant 2024; 38:e15310. [PMID: 38591128 PMCID: PMC11381089 DOI: 10.1111/ctr.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post-transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post-operative disability in patients undergoing lung retransplantation. METHODS Data were collected from the UNOS national dataset and included all patients who underwent lung retransplant from May 2005-March 2023. Pre- and post-operative function was reported by the Karnofsky Performance Status (KPS) and patients were stratified based on their needs. Cumulative link mixed effects models identified associations between pre-transplant variables and post-transplant function. RESULTS A total of 1275 lung retransplant patients were included. After adjusting for between-group differences, pre-operative functional status was predictive of post-transplant function; patients requiring Total Assistance ( n = 740) were 74% more likely than No/Some Assistance patients (n = 535) to require more assistance in follow-up (OR 1.74, 95% CI 1.13-2.68, p = .012). Estimated one year survival of Total Assistance patients is lower than No/Some Assistance Recipients (72% vs. 82%, CI 69%-75%; 79%-86%) but similar to overall re-transplant survival (76%, CI 74%-79%). CONCLUSION Both survival and regain of function in patients requiring Total Assistance prior to retransplant may be higher than previously reported. Pre-operative functional status is predictive of post-operative function and should weigh in the selection, timing and post-operative care of patients considered for lung retransplantation.
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Affiliation(s)
- Rachel L Deitz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sarah Clifford
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Jenalee N Coster
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Masashi Furukawa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Chadi A Hage
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
- Department of Cardiothoracic Surgery, Division of Lung Transplant and Lung Failure, University of Pittsburgh Medical Center, Pittsburgh, USA
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Himebauch AS, Yehya N, Schaubel DE, Josephson MB, Berg RA, Kawut SM, Christie JD. Poor functional status at the time of waitlist for pediatric lung transplant is associated with worse pretransplant outcomes. J Heart Lung Transplant 2023; 42:1735-1742. [PMID: 37437825 PMCID: PMC10776805 DOI: 10.1016/j.healun.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Whether functional status is associated with survival to pediatric lung transplant is unknown. We hypothesized that completely dependent functional status at waitlist registration, defined using Lansky Play Performance Scale (LPPS), would be associated with worse outcomes. METHODS Retrospective cohort study of pediatric lung transplant registrants utilizing United Network for Organ Sharing's Standard Transplant Analysis and Research files (2005-2020). Primary exposure was completely dependent functional status, defined as LPPS score of 10-40. Primary outcome was waitlist removal for death/deterioration with cause-specific hazard ratio (CSHR) regression. Subdistribution hazard regression (SHR, Fine and Gray) was used for the secondary outcome of waitlist removal due to transplant/improvement with a competing risk of death/deterioration. Confounders included: sex, age, race, diagnosis, ventilator dependence, extracorporeal membrane oxygenation, year, and listing center volume. RESULTS A total of 964 patients were included (63.5% ≥ 12 years, 50.2% cystic fibrosis [CF]). Median waitlist days were 95; 20.1% were removed for death/deterioration and 68.2% for transplant/improvement. Completely dependent functional status was associated with removal due to death/deterioration (adjusted CSHR 5.30 [95% CI 2.86-9.80]). This association was modified by age (interaction p = 0.0102), with a larger effect for age ≥12 years, and particularly strong for CF. In the Fine and Gray model, completely dependent functional status did not affect the risk of removal due to transplant/improvement with a competing risk of death/deterioration (adjusted SHR 1.08 [95% CI 0.77-1.49]). CONCLUSIONS Pediatric lung transplant registrants with the worst functional status had worse pretransplant outcomes, especially for adolescents and CF patients. Functional status at waitlist registration may be a modifiable risk factor to improve survival to lung transplant.
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Affiliation(s)
- Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen B Josephson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven M Kawut
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason D Christie
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kristobak BM, Bezinover D, Geyer N, Cios TJ. Decline in Functional Status While on the Waiting List Predicts Worse Survival After Lung Transplantation. J Cardiothorac Vasc Anesth 2022; 36:4370-4377. [PMID: 36163154 DOI: 10.1053/j.jvca.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine if decreases in the Karnofsky Performance Score (KPS) while on the waitlist predict decreased survival after lung transplantation (LTx). DESIGN A retrospective evaluation of the United Network for Organ Sharing database. The KPS was evaluated at the time of listing for transplant and at the time of transplantation. Group I consisted of patients having a decrease in KPS during the time on the waiting list (from the time of listing to the time of transplant), and Group II consisted of patients whose KPS stayed the same or increased during the same period. The authors used propensity-score weighting for comparisons of these groups. SETTING Retrospective observational database review. PARTICIPANTS Adult patients undergoing lung transplantation. INTERVENTIONS None. Patients were stratified according to a change in their KPS. MEASUREMENTS AND MAIN RESULTS Patient and graft survival of patients with decreasing or not decreasing KPS were compared. Of the 27,558 subjects included in the analysis, 17,986 (65%) had worsening KPS, which was associated with worse graft (p = 0.0003) and patient (p = 0.0019) survival after LTx. Using multivariate regression, a decrease in KPS of ≥40 was associated with decreased survival, and an increase of ≥40 was associated with improved survival (HR = 1.245, 95% CI [1.181-1.312], p < 0.0001 and HR = 0.866, 95% CI [0.785, 0.955], respectively). Among patients with a KPS <40 at the time of transplant, those with a decrease in KPS of ≥40 had decreased graft and patient survival compared with those with a smaller decrease (p = 0.0002 and p = 0.0021, respectively). CONCLUSIONS Deterioration of KPS on the waiting list for LTx is associated with significantly greater postoperative mortality in patients after LTx. These results should be taken into consideration when allocating organs. Strategies to increase or to prevent a decrease in KPS before LTx should be evaluated.
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Affiliation(s)
- Benjamin M Kristobak
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Dmitri Bezinover
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Nathaniel Geyer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Theodore J Cios
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA.
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Aggarwal R, Jackson S, Lemke NT, Trager L, Shumway SJ, Kelly RF, Hertz M, Huddleston SJ. Time since primary transplant and poor functional status predict survival after redo lung transplant. J Thorac Dis 2022; 14:3819-3830. [PMID: 36389317 PMCID: PMC9641320 DOI: 10.21037/jtd-22-334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In previous studies, lower functional status measured by Karnofsky Performance Status (KPS) correlated with worse survival after redo lung transplant. We hypothesize that combining reduced functional status and time from primary lung transplant will correlate with the etiology of lung allograft failure after primary lung transplant and more accurately predict survival after redo lung transplant. METHODS This retrospective study was approved by University of Minnesota Institutional Review Board. From the Scientific Registry of Transplant Recipients (SRTR) database, 739 patients underwent redo lung transplant (01/01/2005-8/30/2019). Pre-lung transplant characteristics, KPS, time between primary and redo lung transplant, outcomes, overall survival were evaluated. Paired comparisons were used to compare pre-transplant variables. A Cox regression model was fit to examine re-transplant survival. Due to non-proportional hazards, time between transplants was split into <1-year vs. 1+ years and analyzed with time-dependent coefficients, with follow-up time considered in three segments (0-6, 6-24, 24+ months). RESULTS After KPS grouping (10-40%, 50-70%, 80-100%), KPS 10-40% were less likely to be discharged after primary transplant and more likely required mechanical ventilation or extracorporeal membrane oxygenation (ECMO) bridging (P<0.001). Redo lung transplant survival was worse in the KPS 10-40% group who more likely underwent lung transplant <1 year after primary lung transplant. Mortality was significantly higher for patients who underwent redo lung transplant within one year of primary transplant when KPS was 10-40% (P<0.001). These patients were more likely to require redo lung transplant due to primary graft failure or acute cellular rejection. CONCLUSIONS Functional status and time from primary lung transplant are strong predictors of outcome after redo lung transplant. We categorized redo lung transplant recipients in two distinct groups. One group has early allograft failure and poor functional status with a very poor prognosis after redo lung transplant. The other group has chronic allograft failure and overall better functional status with relatively better survival after redo lung transplant. Salvage redo lung transplant for primary allograft failure or acute rejection is associated with low one year survival.
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Affiliation(s)
- Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Scott Jackson
- Analytics Consulting Services, Solid Organ Transplant, University of Minnesota Medical Center Fairview, Minneapolis, MN, USA
| | - Nicholas T. Lemke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lena Trager
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sara J. Shumway
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rosemary F. Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stephen J. Huddleston
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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Shaw TB, Blitzer D, Carter KT, Lirette S, Mohammed A, Copeland J, Baran DA, Copeland H. Functional status of heart transplant recipients predicts survival. Clin Transplant 2022; 36:e14748. [PMID: 35723881 DOI: 10.1111/ctr.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recipient functional status prior to transplantation can significantly impact post-transplant survival. METHODS The United Network for Organ Sharing database was queried for adult heart transplants including data on functional capacity and from February 1, 2005 to March 1, 2021; there were 32 875 cases included. The four functional categories studied were based on adult daily activities of living and were separated into total assistance required, some assistance required, no assistance required, and near death. Survival outcomes were compared for recipient's pretransplant level of functional status versus those with near death status. These were compared using adjusted logistic regression (odds of death at 30 days and 1 year) and conditional Cox models (overall survival and time until post-transplant rejection). All models were adjusted for donor age, sex, ethnicity, ischemic time, as well as recipient age, sex, ethnicity, length of stay, UNOS region, ventricular assist device, creatinine, days on the waiting list, and status at transplant. RESULTS There were 12 953 recipients classified as "near death" or "severely disabled"; 7711 "required total assistance in daily living", 7,328 "needed some", and 4883 "needed none". In adjusted models, the probabilities of death for the lowest functioning groups within 30 days and 1 year were 5% and 10%, respectively. Those "requiring total assistance" had analogous probabilities of 3% (OR = 0.58; p < 0.001) and 9% (OR = 0.81; p < 0.001). Those "requiring some assistance" had probabilities of 3% (OR = 0.56; p < 0.001) and 9% (OR = 0.74; p < 0.001). Lastly, those "requiring no assistance" had probabilities of death of 2% (OR = 0.35; p < 0.001) and 7% (OR = 0.63; p < 0.001). CONCLUSION Recipient functional status assessed pre-transplant and recorded in the UNOS database is a strong predictor of post-transplant survival.
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Affiliation(s)
- Taylor B Shaw
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David Blitzer
- Department of Surgery, Division of Cardiovascular Surgery, Columbia University, New York, New York, USA
| | - Kristen T Carter
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Asim Mohammed
- Division of Advanced Heart Failure, Heart Transplant and Mechanical Circulatory Support, Lutheran Hospital Fort Wayne, Fort Wayne, Indiana, USA
| | - Jack Copeland
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - David A Baran
- Cleveland Clinic Heart Vascular and Thoracic Institute, Weston, Florida, USA
| | - Hannah Copeland
- Department of Cardiovascular Surgery, Heart Transplant, Mechanical Circulatory Support and Extracorporeal Membrane Oxygenation (ECMO), Lutheran Hospital, Fort Wayne, Indiana, USA.,Indiana University School of Medicine - Fort Wayne (IUSM-FW), Fort Wayne, Indiana, USA
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Murray AW, Boisen ML, Fritz A, Renew JR, Martin AK. Anesthetic considerations in lung transplantation: past, present and future. J Thorac Dis 2022; 13:6550-6563. [PMID: 34992834 PMCID: PMC8662503 DOI: 10.21037/jtd-2021-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023]
Abstract
Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs. Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.
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Affiliation(s)
- Andrew W Murray
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley Fritz
- Division of Cardiothoracic and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - J Ross Renew
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Jacksonville, FL, USA
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Chu NM, Chen X, Bae S, Brennan DC, Segev DL, McAdams-DeMarco MA. Changes in Functional Status Among Kidney Transplant Recipients: Data From the Scientific Registry of Transplant Recipients. Transplantation 2021; 105:2104-2111. [PMID: 33449609 PMCID: PMC8273213 DOI: 10.1097/tp.0000000000003608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With stressors of dialysis prekidney transplantation (KT) and restoration of kidney function post-KT, it is likely that KT recipients experience a decline in functional status while on the waitlist and improvements post-KT. METHODS We leveraged 224 832 KT recipients from the national registry (SRTR, February 1990-May 2019) with measured Karnofsky Performance Status (KPS, 0%-100%) at listing, KT admission, and post-KT. We quantified the change in KPS from listing to KT using generalized linear models. We described post-KT KPS trajectories using adjusted mixed-effects models and tested whether those trajectories differed by age, sex, race, and diabetes status using a Wald test among all KT recipients. We then quantified risk adverse post-KT outcomes (mortality and all-cause graft loss [ACGL]) by preoperative KPS and time-varying KPS. RESULTS Mean KPS declined from listing (83.7%) to admission (78.9%) (mean = 4.76%, 95% confidence interval [CI]: -4.82, -4.70). After adjustment, mean KPS improved post-KT (slope = 0.89%/y, 95% CI: 0.87, 0.91); younger, female, non-Black, and diabetic recipients experienced greater post-KT improvements (Pinteractions < 0.001). Lower KPS (per 10% decrease) at admission was associated with greater mortality (adjusted hazard ratio [aHR] = 1.11, 95% CI: 1.10, 1.11) and ACGL (aHR = 1.08, 95% CI: 1.08, 1.09) risk. Lower post-KT KPS (per 10% decrease; time-varying) were more strongly associated with mortality (aHR = 1.93, 95% CI: 1.92, 1.94) and ACGL (aHR = 1.84, 95% CI: 1.83, 1.85). CONCLUSIONS Functional status declines pre-KT and improves post-KT in the national registry. Despite post-KT improvements, poorer functional status at KT and post-KT are associated with greater mortality and ACGL risk. Because of its dynamic nature, clinicians should repeatedly screen for lower functional status pre-KT to refer vulnerable patients to prehabilitation in hopes of reducing risk of adverse post-KT outcomes.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Singh N, Wagener MM. Cytomegalovirus Serostatus and Functional Impairment in Liver Transplant Recipients in the Current Era. Viruses 2021; 13:v13081519. [PMID: 34452384 PMCID: PMC8402920 DOI: 10.3390/v13081519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Whether donor (D+) or recipient (R+) cytomegalovirus (CMV) seropositivity is associated with functional impairment in liver transplant recipients is not known. METHODS Patients included adult liver transplant recipients in the Organ Procurement and Transplantation Network database transplanted over a five-year period from 1 January 2014-31 December 2018. Functional status in the database was assessed using Karnofsky performance scale. A logistic regression model that controlled for potential confounders was used to examine the association of CMV serostatus and functional status. Variables significantly associated with functional status (p < 0.05) were then used to develop propensity score and propensity score matched analysis was conducted where each patient was compared with a matched-control with the same propensity score. RESULTS Among 30,267 adult liver transplant recipients, D+ or R+ patients had significantly lower functional status at last follow-up than the D-R- cohort (OR 0.88, 95% CI 0.80-0.96, p = 0.007). In propensity score matched model, D+ or R+ patients had significantly lower functional status than matched-controls (p = 0.009). D+ or R+ CMV serostatus (p = 0.018) and low functional level (p < 0.001) were also independently associated with infections as cause-of-death. CONCLUSIONS D+ or R+ liver transplant recipients had lower functional status and higher risk of deaths due to infections. Future studies are warranted to examine the mechanistic basis of these findings in the setting of transplantation.
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Koons B, Siebert J. Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant: Considerations for Critical Care Nursing Practice. Crit Care Nurse 2021; 40:49-57. [PMID: 32476023 DOI: 10.4037/ccn2020918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC Candidates waiting for lung transplant are sicker now than ever before. Extracorporeal membrane oxygenation has become useful as a bridge to lung transplant for these critically ill patients. CLINICAL RELEVANCE Critical care nurses must be prepared to care for the increasing number of lung transplant patients who require this advanced support method. PURPOSE OF PAPER To provide critical care nurses with the foundational knowledge essential for delivering quality care to this high-acuity transplant patient population. CONTENT COVERED This review describes the types of extracorporeal membrane oxygenation (venovenous and venoarterial), provides an overview of the indications and contraindications for extracorporeal membrane oxygenation, and discusses the role of clinical bedside nurses in the treatment of patients requiring extracorporeal membrane oxygenation as a bridge to lung transplant.
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Affiliation(s)
- Brittany Koons
- Brittany Koons is a postdoctoral research fellow at the University of Pennsylvania and a critical care nurse in the cardiothoracic surgical intensive care unit at the Hospital of the University of Pennsylvania, Philadelphia
| | - Jennifer Siebert
- Jennifer Siebert is a Robert Wood Johnson Foundation Future of Nursing Scholar and doctoral student at Villanova University, Villanova, Pennsylvania, and a critical care nurse in the cardiothoracic surgical intensive care unit at the Hospital of the University of Pennsylvania
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Schwarz S, Rahimi N, Kifjak D, Muckenhuber M, Watzenböck M, Benazzo A, Jaksch P, Knapp S, Klepetko W, Hoetzenecker K. Comparison of donor scores in bilateral lung transplantation-A large single-center analysis. Am J Transplant 2021; 21:2132-2144. [PMID: 33210825 PMCID: PMC8259697 DOI: 10.1111/ajt.16402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large-scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN-DLQI, and ODSS). Prediction of organ utilization, 1-year graft survival, and long-term outcome were analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II), and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC: 0.795; CI: 0.776-0.815) and actual donor utilization (AUC: 0.660; CI: 0.618-0.701). Prediction of 1-year graft survival was best using the MALT score, Oto score, and UMN-DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation (LMV), PGD3 rates, ICU stay and hospital stay, and in-hospital-mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, and MALT score and UMN-DLQI for predicting outcome after lung transplantation.
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Affiliation(s)
- Stefan Schwarz
- Division of Thoracic SurgeryMedical University of ViennaWienAustria
| | - Nina Rahimi
- Division of Thoracic SurgeryMedical University of ViennaWienAustria
| | - Daria Kifjak
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaWienAustria
| | | | - Martin Watzenböck
- CeMMResearch Center for Molecular Medicine of the Austrian Academy of SciencesViennaAustria,Department of Medicine I/Research Laboratory of Infection BiologyMedical University of ViennaWienAustria
| | - Alberto Benazzo
- Division of Thoracic SurgeryMedical University of ViennaWienAustria
| | - Peter Jaksch
- Division of Thoracic SurgeryMedical University of ViennaWienAustria
| | - Sylvia Knapp
- CeMMResearch Center for Molecular Medicine of the Austrian Academy of SciencesViennaAustria,Department of Medicine I/Research Laboratory of Infection BiologyMedical University of ViennaWienAustria
| | - Walter Klepetko
- Division of Thoracic SurgeryMedical University of ViennaWienAustria
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Benazzo A, Schwarz S, Frommlet F, Sinn K, Schweiger T, Klikovits T, Hoda AM, Moser B, Matilla JR, Renyi Vamos F, Lang G, Jaksch P, Di Nardo M, Del Sorbo L, Taghavi S, Keshavjee S, Klepetko W, Cypel M, Hoetzenecker K. Donor ventilation parameters as predictors for length of mechanical ventilation after lung transplantation: Results of a prospective multicenter study. J Heart Lung Transplant 2020; 40:33-41. [PMID: 33246712 DOI: 10.1016/j.healun.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval surgeon. As a consequence, acceptance rates vary significantly among transplant centers. We aimed to determine donor ventilation parameters in a prospective study and test if they could be used as objective quality criteria during organ retrieval. METHODS A prospective evaluation of lung donors was performed in 3 transplant centers. Ventilation parameters were collected at the time of retrieval using a standardized ventilation protocol. Recipient length of mechanical ventilation (LMV) was defined as the primary end point, and collected data was used to build linear models predicting LMV. RESULTS In total, 166 donors were included in this study. Median LMV after transplantation was 32 hours (interquartile range: 20-63 hours). Peak inspiratory pressure and dynamic compliance (Cdyn) at the time of retrieval, but not the partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio, correlated with recipient LMV in Spearman correlations (r = 0.280, p = 0.002; r = -0.245, p = 0.003; and r = 0.064, p = 0.432, respectively). Linear models were built to further evaluate the impact of donor ventilation parameters on LMV. The first model was based on donor P/F ratio, donor age, donor intubation time, donor smoking history, donor partial pressure of carbon dioxide, aspiration, chest trauma, and pathologic chest X-ray. This model performed poorly (multiple R-squared = 0.063). In a second model, donor ventilation parameters were included, and Cdyn was identified as the strongest predictor for LMV. The third model was extended by recipient factors, which significantly improved the robustness of the model (multiple R-squared = 0.293). CONCLUSION In this prospective evaluation of donor lung parameters, currently used donor quality criteria poorly predicted recipient LMV. Our data suggest that Cdyn is a strong donor-bound parameter to predict short-term graft performance; however, recipient factors are similarly relevant.
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Affiliation(s)
- Alberto Benazzo
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Katharina Sinn
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Klikovits
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Alireza Mir Hoda
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jose Ramon Matilla
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Ferenc Renyi Vamos
- Department of Thoracic Surgery, Semmelweis University - National Institute of Oncology, Budapest, Hungary
| | - György Lang
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shahrokh Taghavi
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcelo Cypel
- Toronto Lung Transplant Program, Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit. Transplant Direct 2020; 6:e599. [PMID: 32903964 PMCID: PMC7447442 DOI: 10.1097/txd.0000000000001043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 01/16/2023] Open
Abstract
Background. The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described. Methods. We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006–2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio, 95% LCLaHR95%UCL). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group. Results. KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80–100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50–60), 12.4% and 14.2%; and disabled (KPS 10–40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR, 1.001.181.41), requiring assistance (aHR, 1.061.311.60), and disabled (aHR, 1.101.552.19). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR, 0.260.480.88) to 70% for patients with normal functioning (aHR, 0.260.300.34). Conclusions. While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant.
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Hemoptysis from complex pulmonary aspergilloma treated by cavernostomy and thoracoplasty. BMC Surg 2019; 19:187. [PMID: 31805919 PMCID: PMC6894504 DOI: 10.1186/s12893-019-0650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials. METHODS A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation. RESULTS Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. CONCLUSION Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
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18
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Bui K, Kilambi V, Mehrotra S. Functional status-based risk-benefit analyses of high-KDPI kidney transplant versus dialysis. Transpl Int 2019; 32:1297-1312. [PMID: 31323698 PMCID: PMC6874710 DOI: 10.1111/tri.13483] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/25/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022]
Abstract
Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005-2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10-40, 50-70, and 80-100. With KDPI 0-99 KT, KPS 10-40 patients will survive ≥4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to ≥7.83 years after KDPI < 100 KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81-99 KT than from remaining on dialysis.
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Affiliation(s)
- Kevin Bui
- Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Mathematics; University of California, Irvine; Irvine, CA
| | | | - Sanjay Mehrotra
- Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL
- Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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19
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Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased-donor Kidney Recipients. Transplantation 2019; 103:1051-1063. [PMID: 30086093 DOI: 10.1097/tp.0000000000002397] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recorded at the time of transplant and reported to the Organ Procurement and Transplantation Network, patient's functional status is measured using the Karnofsky performance score (KPS), ranging 0 to 100. Functional status analysis may provide insights on candidate listing and posttransplant survival outcomes for deceased-donor kidney transplants. METHODS The cohort consisted of adult deceased-donor kidney transplant recipients transplanted beginning January 2007. One-year and 3-year Cox models for posttransplant survival were fitted with current Scientific Registry of Transplant Recipients (SRTR) variables and KPS. Comparative analyses were performed between the SRTR model without KPS and augmented model with it. Using the augmented model, we examined the impact of Kidney Donor Profile Index on posttransplant survivals for 5 different KPS strata: 10 to 30, 40 to 50, 60 to 70, 80 to 90, and 100. RESULTS Comparative analyses showed that KPS was a statistically significant predictor for posttransplant survival: it improved model calibration, discrimination, and predictive accuracy. From the augmented model, the survival curves illustrated that recipients with KPS 40 to 50 and kidneys with Kidney Donor Profile Index as high as 99 have expected survival probabilities of above 90% in 1 year and above 80% in 3 years. The expected survival probabilities improve as KPS increases. Recipients with KPS 10 to 30 have the worst survival probability, even if they received high-quality kidneys. CONCLUSIONS Insights from the survival analyses recommend possible inclusion of functional status into SRTR's risk-adjusted models. Moreover, they invite further examination of its use to improve current listing and transplantation strategies at transplant centers and potentially reduce deceased-donor kidney discard rate.
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20
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Mooney JJ, Yang L, Hedlin H, Mohabir P, Dhillon GS. Multiple listing in lung transplant candidates: A cohort study. Am J Transplant 2019; 19:1098-1108. [PMID: 30253057 PMCID: PMC6433482 DOI: 10.1111/ajt.15124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant candidates can be waitlisted at more than one transplant center, a practice known as multiple listing. The factors associated with multiple listing and whether multiple listing modifies waitlist mortality or likelihood of lung transplant is unknown. US lung transplant waitlist candidates were identified as either single or multiple listed using data from the Scientific Registry of Transplant Recipients. Characteristics of single and multiple listed candidates were compared and multivariable logistic regression was used to estimate associations with multiple listing. Multiple listed candidates were matched to single listed candidates using a combination of exact and propensity score matching methods. Cox proportional hazard models were used to estimate the relationship of multiple listing on waitlist mortality and receiving a transplant. Multiple listing occurred in 2.3% of lung transplant waitlist candidates. Younger age, female gender, white race, short stature, high antibody sensitization, college or postcollege education, lower lung allocation score, and a cystic fibrosis diagnosis were independently associated with multiple listing. Multiple listing was associated with an increased likelihood of lung transplant (adjusted hazard ratio [aHR] 2.74, 95% CI 2.37 to 3.16) but was not associated with waitlist mortality (aHR 0.99, 95% CI 0.68 to 1.44).
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Affiliation(s)
- Joshua J. Mooney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Lingyao Yang
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Paul Mohabir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Gundeep S Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
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Singer JP, Soong A, Bruun A, Bracha A, Chin G, Hays SR, Kukreja J, Rigler J, Golden JA, Greenland JR, Garvey C. A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study. Clin Transplant 2018; 32:e13274. [PMID: 29742287 DOI: 10.1111/ctr.13274] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty is prevalent in lung transplant candidates (LTC) and is associated with waitlist delisting or death. We performed a pilot study to assess the safety and feasibility of a home-based, mobile health technology-facilitated intervention to treat frailty in LTC. METHODS We performed an 8-week, nonrandomized, home-based exercise and nutrition intervention in LTC with Short Physical Performance Battery (SPPB) frailty scores of ≤11. The intervention utilized a customized, mobile device application ("app") enabling monitoring and progression of the intervention in real time. We aimed to evaluate key process measures. Secondarily, we tested whether the intervention could improve frailty scores quantified by the SPPB and Fried Frailty Phenotype (FFP). RESULTS A total of 15 subjects enrolled were 63 ± 5.7 years old; oxygen requirements ranged from 3 to 15LPM. Thirteen subjects completed the intervention. Over 108 subject-weeks, there were no adverse events. Subjects found the app engaging and easy to work with. SPPB frailty improved in 7 (54%) and FFP improved in 8 (62%). There was a strong trend toward improved frailty scores (SPPB change 1.0 ± 1.9; P = .08; FFP change -0.6 ± 1.0; P = .07). CONCLUSION In this pilot study, we found that a home-based prehabilitation program that leverages mobile health technology to target frailty in LTC is well received, safe, and capable of improving physical frailty scores.
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Affiliation(s)
- Jonathan P Singer
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Allison Soong
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Ayana Bracha
- Department of Nutrition and Food Services, University of California, San Francisco, CA, USA
| | - Greg Chin
- Department of Nutrition and Food Services, University of California, San Francisco, CA, USA
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Julia Rigler
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeff A Golden
- Department of Medicine, University of California, San Francisco, CA, USA
| | - John R Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chris Garvey
- Department of Medicine, University of California, San Francisco, CA, USA
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Osho A, Mulvihill M, Lamba N, Hirji S, Yerokun B, Bishawi M, Spencer P, Panda N, Villavicencio M, Hartwig M. Is Functional Independence Associated With Improved Long-Term Survival After Lung Transplantation? Ann Thorac Surg 2018; 106:79-84. [PMID: 29501640 DOI: 10.1016/j.athoracsur.2018.01.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Existing research demonstrates superior short-term outcomes (length of stay, 1-year survival) after lung transplantation in patients with preoperative functional independence. The aim of this study was to determine whether advantages remain significant in the long-term. METHODS The United Network for Organ Sharing database was queried for adult, first-time, isolated lung transplantation records from January 2005 to December 2015. Stratification was performed based on Karnofsky Performance Status Score (3 groups) and on employment at the time of transplantation (2 groups). Kaplan-Meier and Cox analyses were performed to determine the association between these factors and survival in the long-term. RESULTS Of 16,497 patients meeting criteria, 1,581 (9.6%) were almost completely independent at the time of transplant vs 5,662 (34.3%) who were disabled (completely reliant on others for activities of daily living). Cox models adjusting for recipient, donor, and transplant factors demonstrated a statistically significant association between disability at the time of transplant and long-term death (hazard ratio, 1.26; 95% confidence interval, 1.14 to 1.40; p < 0.001). There were 15,931 patients with available data on paid employment at the time of transplantation. Multivariable analysis demonstrated a statistically significant association between employment at the time of transplantation and death (hazard ratio, 0.86; 95% confidence interval, 0.75 to 0.91; p < 0.001). CONCLUSIONS Preoperative functional independence and maintenance of employment are associated with superior long-term outcomes in lung recipients. The results highlight potential benefits of pretransplant functional rehabilitation for patients on the waiting list for lungs.
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Affiliation(s)
- Asishana Osho
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Michael Mulvihill
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nayan Lamba
- Harvard Medical School, Boston, Massachusetts
| | - Sameer Hirji
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Babatunde Yerokun
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Muath Bishawi
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Philip Spencer
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Matthew Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Lee SH, Park MS, Song JH, Kim YS, Lee JG, Paik HC, Kim SY. Perioperative factors associated with 1-year mortality after lung transplantation: a single-center experience in Korea. J Thorac Dis 2017; 9:4006-4016. [PMID: 29268411 DOI: 10.21037/jtd.2017.09.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Most studies about the risk factors of 1-year mortality after lung transplantation were performed on non-Asians. This study aimed to evaluate the perioperative factors related to the 1-year mortality after lung transplantation in Korea. Methods Sixty-eight consecutive patients who underwent lung transplantation without preoperative extracorporeal membrane oxygenation treatment at 1 tertiary hospital in South Korea between October 24, 2012, and October 16, 2015, were analyzed retrospectively. Results Forty-four patients (64.7%) lived for >1 year after lung transplantation. The median age of all patients was 55 years (range, 16-75 years), and men accounted for 57.4%. The major cause of lung transplantation was idiopathic pulmonary fibrosis (48.5%); the other causes were interstitial lung disease related to connective tissue disease (17.6%) and bronchiolitis obliterans after stem cell transplantation (14.7%). In univariate analysis, higher median age (52 vs. 61.5 years, P<0.001), male sex (45.5% vs. 79.2%, P=0.007), lower preoperative albumin level (<3 g/dL) (22.7% vs. 45.8%, P=0.049), need for renal replacement therapy (RRT) after surgery (4.5% vs. 37.5%, P=0.001), and postoperative delta neutrophil index (DNI) >5.5 higher than the preoperative DNI (22.7% vs. 70.8%, P<0.001) were significantly related to 1-year mortality. After adjustments, old age, postoperative increased DNI, and need for RRT after transplantation were the independent perioperative risk factors for 1-year mortality after lung transplantation. Conclusions Recipients with advanced age should be carefully selected, and patients who need RRT or with increased DNI after transplantation should be managed accordingly.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Lung Transplant Mortality Is Improving in Recipients With a Lung Allocation Score in the Upper Quartile. Ann Thorac Surg 2017; 103:1607-1613. [PMID: 28223052 DOI: 10.1016/j.athoracsur.2016.11.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/25/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Since the introduction of the Lung Allocation Score (LAS), the mean LAS has risen. Still, it remains uncertain whether mortality has improved in the most severely ill lung transplant recipients over this time period. METHODS Using the United Network for Organ Sharing database, we identified 3,548 adult lung transplant recipients from May 4, 2005, to March 31, 2014, with a match-time LAS in the upper quartile (>75th%ile). We divided this population across three eras: 1 = May 4, 2005, to December 31, 2008 (n = 1,280); 2 = January 1, 2009, to December 31, 2011 (n = 1,266); and 3 = January 1, 2012, to March 31, 2014 (n = 1,002). Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality to assess the independent impact of the era of transplantation. RESULTS The mean LAS at time of transplant for patients in the upper quartile in eras 1, 2, and 3 was 63, 73, and 79, respectively (p < 0.001). Later eras of transplantation benefited from a significant improvement in survival at 1 year (log-rank p = 0.001) but not at 30 days (log-rank p = 0.152). After risk adjustment, lung transplantation in more recent eras was associated with improved mortality at both 30 days (era 3 hazard ratio [HR] = 0.50, 95% confidence interval [CI] 0.32% to 0.78%, p = 0.002) and 1 year (era 2 HR = 0.77, 95% CI 0.64% to 0.94%, p = 0.008; era 3 HR = 0.54, 95% CI 0.43% to 0.68%, p < 0.001). CONCLUSIONS Despite a progressively rising LAS, survival is improving among recipients with the highest LAS at the time of lung transplantation. This calls into question the notion of a maximum LAS beyond which lung transplantation becomes futile, a so-called LAS ceiling.
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Weig T, Milger K, Langhans B, Janitza S, Sisic A, Kenn K, Irlbeck T, Pomschar A, Johnson T, Irlbeck M, Behr J, Czerner S, Schramm R, Winter H, Neurohr C, Frey L, Kneidinger N. Core Muscle Size Predicts Postoperative Outcome in Lung Transplant Candidates. Ann Thorac Surg 2016; 101:1318-25. [DOI: 10.1016/j.athoracsur.2015.10.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/06/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022]
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26
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Andersen KH, Schultz HHL, Nyholm B, Iversen MP, Gustafsson F, Carlsen J. Pulmonary hypertension as a risk factor of mortality after lung transplantation. Clin Transplant 2016; 30:357-64. [DOI: 10.1111/ctr.12692] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kasper H. Andersen
- Department of Cardiology; Section for Pulmonary Hypertension and Right Heart Failure; Copenhagen University Hospital; Rigshospitalet Denmark
| | - Hans Henrik L. Schultz
- Department of Cardiology; Section for Lung Transplantation; Copenhagen University Hospital; Rigshospitalet Denmark
| | - Benjamin Nyholm
- Department of Cardiology; Section for Pulmonary Hypertension and Right Heart Failure; Copenhagen University Hospital; Rigshospitalet Denmark
| | - Martin P. Iversen
- Department of Cardiology; Section for Lung Transplantation; Copenhagen University Hospital; Rigshospitalet Denmark
| | - Finn Gustafsson
- Department of Cardiology, Section for Heart Transplantation; Copenhagen University Hospital; Rigshospitalet Denmark
| | - Jørn Carlsen
- Department of Cardiology; Section for Pulmonary Hypertension and Right Heart Failure; Copenhagen University Hospital; Rigshospitalet Denmark
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Grimm JC, Valero V, Magruder JT, Kilic A, Dungan SP, Silhan LL, Shah PD, Kim BS, Merlo CA, Sciortino CM, Shah AS. A novel risk score that incorporates recipient and donor variables to predict 1-year mortality in the current era of lung transplantation. J Heart Lung Transplant 2015; 34:1449-54. [PMID: 26275639 DOI: 10.1016/j.healun.2015.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/10/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In this study we sought to construct a novel scoring system to pre-operatively stratify a patient's risk of 1-year mortality after lung transplantation (LTx) based on recipient- and donor-specific characteristics. METHODS The UNOS database was queried for adult (≥18 years) patients undergoing LTx between May 1, 2005 and December 31, 2012. The population was randomly divided in a 4:1 fashion into derivation and validation cohorts. A multivariable logistic regression model for 1-year mortality was constructed within the derivation cohort. Points were then assigned to independent predictors (p < 0.05) based on relative odds ratios. Risk groups were established based on score ranges. RESULTS During the study period, 9,185 patients underwent LTx and the 1-year mortality was 18.0% (n = 1,654). There was a similar distribution of variables between the derivation (n = 7,336) and validation (n = 1,849) cohorts. Of the 14 covariates included in the final model, 9 were ultimately allotted point values (maximum score = 70). The model exhibited good predictive strength (c = 0.65) in the derivation cohort and demonstrated a strong correlation between the observed and expected rates of 1-year mortality in the validation cohort (r = 0.87). The low-risk (score 0 to 11), intermediate-risk (score 12 to 21) and high-risk (score ≥22) groups had a 10.8%, 17.1% and 32.0% risk of mortality (p < 0.001), respectively. CONCLUSIONS This is the first scoring system that incorporates both recipient- and donor-related factors to predict 1-year mortality after LTx. Its use could assist providers in the identification of patients at highest risk for poor post-transplant outcomes.
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Affiliation(s)
- Joshua C Grimm
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Vicente Valero
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - J Trent Magruder
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Arman Kilic
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Samuel P Dungan
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Leann L Silhan
- Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Pali D Shah
- Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Bo S Kim
- Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christian A Merlo
- Division of Pulmonary and Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Ashish S Shah
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
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