Factors indicative of long-term survival after lung transplantation: A review of 836 10-year survivors

Eric S. Weiss, Jeremiah G. Allen, Christian A. Merlo, John V. Conte, Ashish S. Shah

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)240-246
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume29
Issue number3
DOIs
StatePublished - Mar 1 2010

Fingerprint

Lung Transplantation
Survivors
Odds Ratio
Confidence Intervals
Hospitalization
Survival
Logistic Models
Bronchiolitis Obliterans
Idiopathic Pulmonary Fibrosis
Infection
Cystic Fibrosis
Chronic Obstructive Pulmonary Disease
Case-Control Studies
Tissue Donors
Datasets

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Weiss, Eric S. ; Allen, Jeremiah G. ; Merlo, Christian A. ; Conte, John V. ; Shah, Ashish S. / Factors indicative of long-term survival after lung transplantation : A review of 836 10-year survivors. In: Journal of Heart and Lung Transplantation. 2010 ; Vol. 29, No. 3. pp. 240-246.
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abstract = "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.",
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Factors indicative of long-term survival after lung transplantation : A review of 836 10-year survivors. / Weiss, Eric S.; Allen, Jeremiah G.; Merlo, Christian A.; Conte, John V.; Shah, Ashish S.

In: Journal of Heart and Lung Transplantation, Vol. 29, No. 3, 01.03.2010, p. 240-246.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors indicative of long-term survival after lung transplantation

T2 - A review of 836 10-year survivors

AU - Weiss, Eric S.

AU - Allen, Jeremiah G.

AU - Merlo, Christian A.

AU - Conte, John V.

AU - Shah, Ashish S.

PY - 2010/3/1

Y1 - 2010/3/1

N2 - 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.

AB - 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.

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