TY - JOUR
T1 - Evolution of recipient characteristics over 3 decades and impact on survival after lung transplantation
AU - Elgharably, Haytham
AU - Ayyat, Kamal S.
AU - Okamoto, Toshihiro
AU - Thuita, Lucy
AU - Unai, Shinya
AU - Bribriesco, Alejandro C.
AU - Yun, James J.
AU - Johnston, Douglas R.
AU - Ahmad, Usman
AU - Murthy, Sudish C.
AU - Budev, Marie M.
AU - Pettersson, Gosta B.
AU - McCurry, Kenneth R.
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background. Lung transplantation (LTx) is a definitive treatment for end-stage lung disease. Herein, we reviewed our center experience over 3 decades to examine the evolution of recipient characteristics and contemporary predictors of survival for LTx. Methods. We retrospectively reviewed the data of LTx procedures performed at our institution from January 1990 to January 2019 (n=1819). The cohort is divided into 3 eras; I: 1990–1998 (n=152), II: 1999–2008 (n=521), and III: 2009–2018 (n=1146). Univariate and multivariate analyses of survival in era III were performed. Results. Pulmonary fibrosis has become the leading indication for LTx (13% in era I, 57% in era III). Median recipient age increased (era I: 46 y–era III: 61 y) as well as intraoperative mechanical circulatory support (era I: 0%–era III: 6%). Higher lung allocation score was associated with primary graft dysfunction (P<0.0001), postoperative extracorporeal mechanical support (P<0.0001), and in-hospital mortality (P = 0.002). In era III, hypoalbuminemia, thrombocytopenia, and high primary graft dysfunction grade were multivariate predictors of early mortality. The 5-y survival in eras II (55%) and III (55%) were superior to era I (40%, P<0.001). Risk factors for late mortality in era III included recipient age, chronic allograft dysfunction, renal dysfunction, high model for end-stage liver disease score, and single LTx. Conclusions. In this longitudinal single-center study, recipient characteristics have evolved to include sicker patients with greater complexity of procedures and risk for postoperative complications but without significant impact on hospital mortality or long-term survival. With advancing surgical techniques and perioperative management, there is room for further progress in the field.
AB - Background. Lung transplantation (LTx) is a definitive treatment for end-stage lung disease. Herein, we reviewed our center experience over 3 decades to examine the evolution of recipient characteristics and contemporary predictors of survival for LTx. Methods. We retrospectively reviewed the data of LTx procedures performed at our institution from January 1990 to January 2019 (n=1819). The cohort is divided into 3 eras; I: 1990–1998 (n=152), II: 1999–2008 (n=521), and III: 2009–2018 (n=1146). Univariate and multivariate analyses of survival in era III were performed. Results. Pulmonary fibrosis has become the leading indication for LTx (13% in era I, 57% in era III). Median recipient age increased (era I: 46 y–era III: 61 y) as well as intraoperative mechanical circulatory support (era I: 0%–era III: 6%). Higher lung allocation score was associated with primary graft dysfunction (P<0.0001), postoperative extracorporeal mechanical support (P<0.0001), and in-hospital mortality (P = 0.002). In era III, hypoalbuminemia, thrombocytopenia, and high primary graft dysfunction grade were multivariate predictors of early mortality. The 5-y survival in eras II (55%) and III (55%) were superior to era I (40%, P<0.001). Risk factors for late mortality in era III included recipient age, chronic allograft dysfunction, renal dysfunction, high model for end-stage liver disease score, and single LTx. Conclusions. In this longitudinal single-center study, recipient characteristics have evolved to include sicker patients with greater complexity of procedures and risk for postoperative complications but without significant impact on hospital mortality or long-term survival. With advancing surgical techniques and perioperative management, there is room for further progress in the field.
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U2 - 10.1097/TP.0000000000003756
DO - 10.1097/TP.0000000000003756
M3 - Article
C2 - 33988333
AN - SCOPUS:85115242423
SN - 0041-1337
VL - 105
SP - E387-E394
JO - Transplantation
JF - Transplantation
IS - 12
ER -