Does lung transplantation confer a survival benefit?
OBJECTIVE
There are reasonably compelling data documenting the beneficial impact of lung transplantation on functional status, hemodynamics, and quality of life. Demonstration of a survival benefit has been more problematic, largely due to significant constraints on long-term survival. This article reviews the current literature addressing the question of whether transplantation is truly a life-extending procedure.


RESULTS
Because randomized trials are nonexistent, the question has been approached by comparing observed posttransplant survival to wait list survival, or by simulating survival with and without transplantation by statistical modeling. Studies uniformly suggest that transplantation extends survival for patients with idiopathic pulmonary fibrosis. For patients with chronic obstructive pulmonary disease, studies are conflicting and suggest that survival benefit is largely restricted to a subset of patients with extremely severe airflow obstruction who undergo bilateral lung transplantation. Cystic fibrosis (CF) adults with a predicted 5-year survival of less than 50%, and without Burkholderia cepacia or arthropathy appear most likely to realize a survival benefit. Whether transplantation extends survival for pediatric CF patients remains controversial.


CONCLUSIONS
Questions about the survival benefit of lung transplantation linger. In the absence of definitive answers, it may be most appropriate to view transplant as a procedure that enhances the quality but not necessarily the duration of life.
Kotloff
Robert M
RM
Section of Advanced Lung Disease and Lung Transplantation, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA. kotloffr@uphs.upenn.edu
D006084:Graft Rejection / Q000401:mortality*; D006801:Humans; D008171:Lung Diseases / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology