Individuals with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD) do not benefit from being listed as “bilateral transplantation only” compared with being listed as “unrestricted,” according to a study published in Annals of American Thoracic Society. In fact, listing suitable patients with unrestricted procedure preferences could increase the rate of transplants performed.
Researchers carried out a retrospective cohort study of 12,155 adults with COPD or ILD who were listed for lung transplant between 2005 and 2014. They categorized participants as restricted for bilateral transplantation only and unrestricted for combinations of bilateral or single lung transplantation. The primary outcome data included events before and after transplantation, days between transplant listing and death, and removal from the transplant list.
After adjusted analyses, individuals with COPD who were listed as unrestricted demonstrated a 6% lower rate of the intention-to-treat outcome (adjusted hazard ratio (aHR) 0.94; 95% CI, 0.86-1.03) and individuals with ILD had a 1% higher rate of the outcome (aHR 1.01; 95% CI, 0.94-1.07). In individuals with ILD and concomitant severe pulmonary hypertension, an unrestricted preference was associated with a 17% increased rate of the primary outcome (aHR 1.17; 95% CI, 0.99-1.39). The researchers found no evidence that these links varied by age, severity of disease, or mechanical support.
Among individuals with COPD listed as unrestricted, 9% died while on the waiting list, 45% died after transplantation, and 2% underwent retransplantation. Among individuals with COPD listed as restricted, 12% died while on the waiting list, 38% died after transplant, and 1% underwent retransplantation. Among those with ILD listed as unrestricted, 15% died while on the waiting list, 41% died after transplantation, and 3% underwent retransplantation. Among those with ILD listed as restricted, 20% died while on the waiting list, 40% died after transplantation, and 3% underwent retransplantation. Graft failure was similar in patients listed as restricted and unrestricted in both groups.
The researchers concluded that they were “unable to detect meaningful associations between procedural listing preference and ‘intention-to-treat’ survival outcomes following placement on the lung transplant waiting list in a contemporary cohort of US adults with COPD or ILD.”
Anderson MR, Tabah A, RoyChoudhury A, Lederer D. Procedure preference and “intention-to-treat” outcomes after listing for lung transplantation among U.S. adults: a cohort study [published online September 5, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201804-258OC