Document Detail


Bronchiolitis obliterans syndrome occurs earlier in the post-lung allocation score era.
MedLine Citation:
PMID:  21320711     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: In 2005, the time-based waiting list for lung transplantation was replaced by an illness/benefit lung allocation score (LAS). Although short-term outcomes after transplantation have been reported to be similar before and after the new system, little is known about long-term results. The objective of this study was to evaluate the impact of LAS on the development of bronchiolitis obliterans syndrome as well as on overall 3-year and bronchiolitis obliterans syndrome-related survival.
METHODS: Data obtained from the United Network for Organ Sharing were used to review 8091 patients who underwent lung transplantation from 2002 to 2008. Patients were stratified according to time of transplantation into those treated before initiation of the LAS (pre-LAS group, January 2002-April 2005, n = 3729) and those treated after implementation of the score (post-LAS group, May 2005-May 2008, n = 4362). Overall, 3-year survivals for patient groups were compared using a univariate analysis, Cox proportional hazards model to generate a relative risk, and Kaplan-Meier curve analyses.
RESULTS: During the 3-year follow-up period, bronchiolitis obliterans syndrome developed in 22% of lung transplant recipients (n = 1801). Although the incidence of postoperative bronchiolitis obliterans syndrome development was similar between groups, post-LAS patients incurred fewer bronchiolitis obliterans syndrome-free days (609 ± 7.5 vs 682 ± 9; P <.0001; log-rank test P = .0108) than did pre-LAS patients. Overall 3-year survival was lower in post-LAS patients and approached statistical significance (P = .05). Similarly, bronchiolitis obliterans syndrome-related survival was worse for patients in the post-LAS group (log-rank test P = .01).
CONCLUSIONS: In the current LAS era, lung transplant recipients have significantly fewer bronchiolitis obliterans syndrome-free days after 3-year follow-up. Compared with the pre-LAS population, overall and bronchiolitis obliterans syndrome-related survival appears worse in the post-LAS era. Limitation of known risk factors for development of bronchiolitis obliterans syndrome-may prove even more important in this patient population.
Authors:
Abbas Emaminia; Sara A Hennessy; Tjasa Hranjec; Damien J LaPar; Benjamin D Kozower; David R Jones; Irving L Kron; Christine L Lau
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-02-12
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-18     Completed Date:  2011-06-17     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1278-82     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bronchiolitis Obliterans / etiology*,  mortality
Chi-Square Distribution
Female
Humans
Kaplan-Meier Estimate
Lung Transplantation / adverse effects*,  mortality
Male
Middle Aged
Patient Selection*
Proportional Hazards Models
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Syndrome
Time Factors
Tissue and Organ Procurement*
Treatment Outcome
United States
Waiting Lists
Grant Support
ID/Acronym/Agency:
T32 HL007849/HL/NHLBI NIH HHS; T32 HL007849-11A1/HL/NHLBI NIH HHS
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