Assessment of survival benefit after lung transplantation by patient diagnosis.
BACKGROUND
Lung transplantation has become an established procedure for treating patients with endstage lung disease, resulting in broadening criteria for recipient selection. The survival benefit for some patient groups has yet to be established.


METHODS
We reviewed 653 patients accepted for lung transplantation at our center. Patients were categorized into 6 diagnosis groups: cystic fibrosis (174), obstructive lung disease (163), pulmonary fibrosis (100), Eisenmenger's syndrome (76), pulmonary hypertension (68), bronchiectasis (51), and other (21). Using Cox regression, we estimated the time at which early operative risk of death fell below pre-operative risk levels (crossover point) and the point at which early high post-operative risk was offset by later low risk (equity point). The relative benefits of single lung vs double lung/heart-lung transplantation were assessed for patients with obstructive lung disease and pulmonary fibrosis.


RESULTS
Post-operative risk of death fell below pre-operative risk levels for all diagnosis groups, indicating a survival advantage. The equity point was achieved for all distinct diagnosis groups (except Eisenmenger's); this survival benefit was significant for patients with obstructive lung disease, cystic fibrosis, and pulmonary hypertension. Single lung vs double lung/ heart-lung comparisons showed no significant difference in survival benefit.


CONCLUSIONS
All survival benefit patient groups achieve after lung transplantation, with the exception of patients with Eisenmenger's syndrome, who may have prolonged survival while listed. Differences in survival benefit between single lung and double or heart-lung transplantation are not significant for patients with obstructive lung disease or pulmonary fibrosis.
Charman
Susan C
SC
Papworth Hospital National Health Service (NHS) Trust, Papworth Everard, Institute of Public Health, University Forvie Site, Cambridge, United Kingdom.
Sharples
Linda D
LD
McNeil
Keith D
KD
Wallwork
John
J
D000328:Adult; D018592:Cross-Over Studies; D004541:Eisenmenger Complex / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008017:Life Expectancy; D008171:Lung Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists