Thoracic: Lung Transplantation
Factors associated with short- versus long-term survival after lung transplant

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Abstract

Objective

A small but growing proportion of lung transplant recipients survive longer than a decade post-transplant. The aim of this study was to identify factors associated with survival beyond a decade after lung transplant.

Methods

We queried the United Network for Organ Sharing registry for adult (age ≥18 years) recipients undergoing first-time isolated lung transplantation between the introduction of the Lung Allocation Score in 2005 and 2009. Recipients were stratified into 3 cohorts: those who survived less than 1 year, 1 to 10 years, and greater than 10 years. Multivariable logistic regression was used to identify factors independently associated with early mortality (<1 year) and long-term (>10 years) survival.

Results

A total of 5171 lung transplant recipients and their associated donors met inclusion criteria, including 964 (18.6%) with early mortality, 2843 (55.0%) with intermediate survival, and 1364 (26.3%) long-term survivors. Factors independently associated with early mortality included donor Black race, cigarette use, arterial oxygen partial pressure/fractional inspired oxygen ratio, diabetes, recipient Lung Allocation Score, total bilirubin, extracorporeal membrane oxygenation bridge requirement, single lung transplantation, and annual lung transplant center volume. The only factors independently associated with long-term survival among those who survived at least 1 year was donor age and single lung transplantation.

Conclusions

Of patients undergoing lung transplantation after the implementation of the Lung Allocation Score, approximately one-quarter survived 10 years post-transplant. There was minimal overlap between the factors associated with 1-year and 10-year survival. Of note, the Lung Allocation Score was not associated with long-term survival. Further research is needed to better refine patient selection and optimize management strategies to increase the number of long-term survivors.

Key Words

LAS
long-term survival
lung allocation score
lung transplantation

Abbreviations and Acronyms

aOR
adjusted odds ratio
BMI
body mass index
CI
confidence interval
DCD
donation after circulatory death
LAS
Lung Allocation Score
P/F ratio
PaO2/FiO2 ratio
pTLC
predicted total lung capacity
UNOS
United Network for Organ Sharing

Cited by (0)

Funding for this study was provided by National Institutes of Health Grants 5T32HL069749 (to O.K.J.) and 5T32CA093245 (to V.R.). This work was supported in part by Health Resources and Services Administration Contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.