Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Elgharably, Haytham; Ayyat, Kamal S.; Okamoto, Toshihiro; Thuita, Lucy; Unai, Shinya; Bribriesco, Alejandro C.; Yun, James J.; Johnston, Douglas R.; Ahmad, Usman; Murthy, Sudish C.; Budev, Marie M.; Pettersson, Gosta B.; McCurry, Kenneth R.
• Is Part Of: Transplantation. Volume 105:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000003756
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text.