title: Survival impact of lung transplantation for COPD.
abstract: Chronic obstructive pulmonary disease (COPD) is the primary indication for lung transplantation (LTx), but survival benefit is still under debate. We analysed the survival impact of LTx in COPD with a new approach, using the BODE (body mass index, airway obstruction, dyspnoea, exercise capacity) index. We retrospectively reviewed 54 consecutive lung transplants performed for COPD. The pre-transplant BODE score was calculated for each patient and a predicted survival was derived from the survival functions of the original BODE index validation cohort. Predicted and observed post-transplant survival was then compared. In the subgroups with a BODE score >or=7 and <7, a majority of patients (66% and 69%, respectively) lived for longer after LTx than predicted by their individual BODE index. The median survival was significantly improved in the entire cohort and in the subgroup with a BODE score >or=7. 4 yrs after LTx a survival benefit was only apparent in patients with a pre-transplant BODE score of >or=7. In conclusion, while a majority of COPD patients had an individual survival benefit from LTx regardless of their pre-transplant BODE score, a global survival benefit was seen only in patients with more severe disease. This supports the use of the BODE index as a selection criteria for LTx candidates.
authors.affiliation: Service de Pneumologie, Centre Hospitalier Universitaire, Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Lahzami
authors.forename: P O
authors.initials: PO
authors.lastname: Bridevaux
authors.forename: P M
authors.initials: PM
authors.lastname: Soccal
authors.forename: J
authors.initials: J
authors.lastname: Wellinger
authors.forename: J H
authors.initials: JH
authors.lastname: Robert
authors.forename: H B
authors.initials: HB
authors.lastname: Ris
authors.forename: J D
authors.initials: JD
authors.lastname: Aubert
mesh_terms: D004417:Dyspnea / Q000601:surgery; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index