The Journal of Heart and Lung Transplantation
Volume 29, Issue 3 , Pages 240-246, March 2010

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.

  • Eric S. Weiss, MD, MPH

      Affiliations

    • Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • ,
  • Jeremiah G. Allen, MD

      Affiliations

    • Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • ,
  • Christian A. Merlo, MD, MPH

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • Bloomberg School of Public Health, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • ,
  • John V. Conte, MD

      Affiliations

    • Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • ,
  • Ashish S. Shah, MD

      Affiliations

    • Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
    • Corresponding Author InformationReprint requests: Ashish S. Shah, MD, Assistant Professor of Surgery, Director, Lung Transplant Program, Division of Cardiac Surgery, The Johns Hopkins Hospital, Blalock 618, 600 N. Wolfe St, Baltimore, MD 21287. Telephone: 410-502-3900. Fax: 410-955-3809

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.

KEYWORDS: lung transplantation, united network for organ sharing database, survival

 

PII: S1053-2498(09)00532-4

doi:10.1016/j.healun.2009.06.027

The Journal of Heart and Lung Transplantation
Volume 29, Issue 3 , Pages 240-246, March 2010

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