Original Articles
Lung transplant waiting list: differential outcome of type of end-stage lung disease, one year after registration

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Abstract

Background

Donor lung scarcity, distinct natural courses of the different types of end-stage lung diseases, and lung allocation schemes demand appropriate candidate acceptance for a lung transplant and time of listing. This study was undertaken to investigate the association between type of end-stage lung disease and outcome, 1 year after a lung transplant candidate was put on the waiting list.

Methods

From 1990 to 1995, 1376 adult patients were registered for a first lung (n = 1006) or heart-lung (n = 370) transplantation in Eurotransplant. All patients were followed for at least 1 year. For each type of end-stage lung disease (cystic fibrosis, pulmonary fibrosis, emphysema, pulmonary hypertension, congenital heart disease, and other), chances of transplantation, of death on the waiting list, and of removal for other reasons, 1 year after listing, were calculated with the competing risks method. A multivariate Cox regression model was used to assess the influence of the type of end-stage lung disease on the waiting list outflow among other prognostic variables.

Results

Lung transplant candidates with emphysema and with pulmonary fibrosis had the highest chance of a transplant; however, patients with pulmonary fibrosis had also the highest probability of dying while waiting, while the emphysema patients and those with the type “other” had the lowest probability. In the multivariate analysis, the type of end-stage lung disease appeared as an independent prognostic factor for both outcomes. Compared to the patients with cystic fibrosis (reference group), only patients with pulmonary fibrosis had a significantly higher chance of a transplant (RR = 1.50); the lowest chance of death for the emphysema and the “other” patients was confirmed (RR = 0.53 and RR = 0.51, respectively). Recipient size, AB0 blood group, country and epoch of listing also had a significant impact on the transplant chance, while country of listing and recipient age were the other factors independently influencing the chance of dying on the waiting list.

On the heart-lung waiting list, the type of end-stage lung disease solely affected the chance of death prior to transplant. Compared with cystic fibrosis, pulmonary fibrosis had a significantly higher risk (RR = 2.93), closely followed by pulmonary hypertension (RR = 2.57). Factors crucial for the chance of a heart-lung transplant were recipient size, AB0 blood group and country of listing.

Conclusions

The type of end-stage lung disease is a distinctive factor for predicting survival on the lung and heart-lung transplant waiting list, and should be taken into account whenever assessing waiting list outcomes. When developing lung allocation schemes, it is medically justified to incorporate the type of end-stage lung disease.

Section snippets

Methods

This study included all 1376 adult patients (age ≥ 16 years) who were registered for a first lung or heart-lung transplant on the ET waiting list between January 1, 1990 and December 31, 1995. The decision of either lung or heart-lung transplantation was made by the treating transplant physician. The end-stage lung diseases were grouped into 6 types: cystic fibrosis, pulmonary fibrosis, emphysema, pulmonary hypertension, congenital heart disease, and other (Table I). We assumed that all

Results

Seventy-three percent of the patients were listed for a lung transplant (n = 1006), whereas a heart-lung transplantation was requested in 27% (n = 370) (Table I). In the cohort awaiting a lung transplant, the 2 most frequent types of end-stage lung disease were emphysema (33%) and pulmonary fibrosis (26%); a heart-lung transplant was mainly demanded for patients with pulmonary hypertension (39%) and congenital heart disease (26%).

Median recipient height, median recipient age, and the

Discussion

Our study shows that, for adult transplant candidates waiting for a first lung or heart-lung transplantation, the type of end-stage lung disease is indeed one of the factors significantly determining the outcome, 1 year after their registration on the waiting list. The factor “type of end-stage lung disease” had an independent effect on the chance of death while awaiting a lung as well as a heart-lung transplantation, and on the chance of transplantation for lung transplant candidates.

Looking

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Copyright © 1999 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.