Factors indicative of long-term survival after lung transplantation: A review of 836 10-year survivors
Presented at the Twenty-ninth Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, Paris, France, April 22–25, 2009.
published online 23 November 2009.
Introduction
Despite 20 years of lung transplantation (LTx), factors influencing long-term survival remain largely unknown. The United Network for Organ Sharing (UNOS) data set provides an opportunity to examine long-term LTx survivors.
Methods
We conducted a case-control study embedded within the prospectively collected UNOS LTx cohort to identify 836 adults from 1987 to 1997 who survived ≥10 years after first LTx. LTx patients within the same era and surviving 1 to 5 years served as controls. Multivariable logistic regression with incorporation of spline terms evaluated the odds of being a 10-year survivor. Two separate models were constructed. Model A incorporated pre-operative, operative, and donor-specific factors. Model B incorporated the factors used in Model A with post-operative covariates. Additional outcomes evaluated included hospitalizations for infection, rejection, and bronchiolitis obliterans.
Results
Of 4,818 LTx patients from 1987 to 1997, 836 (17.3%) survived ≥10 years with a mean follow-up of 148.8 ± 21.6 months. Mean follow-up for 1,657 controls was 34.0 ± 13.9 months. The distribution of 10-year survivors by disease was cystic fibrosis, 170 (20%); chronic obstructive pulmonary disease, 254 (30%); and idiopathic pulmonary fibrosis, 92 (11%). On multivariable logistic regression, significant factors influencing 10-year survival included age ≤35 years (odds ratio [OR] 1.07, 95% confidence interval [CI], 1.03–1.11; p = 0.01), bilateral LTx (OR. 1.71; 95% CI, 1.25–2.34; p = 0.001), and hospitalizations for infections (OR, 1.40; 95% CI, 1.27–1.54; p < 0.001) and for rejection (OR, 0.55; 95% CI, 0.48–0.65; p < 0.001).
Conclusions
Examination of a cohort of long-term LTx survivors in the UNOS data set indicates that bilateral LTx and fewer hospitalizations for rejection may portend improved long-term survival after LTx.
ABSTRACT