title: Characteristics, interventions, and outcomes of lung transplant recipients co-managed with palliative care.
abstract: BACKGROUND
  Lung transplantation (LT) recipients carry a high symptom burden. Palliative Care (PC) is a field of medicine focused on symptom control and psychosocial support, but transplant recipients are often referred to PC very late in the disease course, if at all. In our institution, the LT service has increasingly consulted PC to co-manage LT recipients with end-stage graft dysfunction or other terminal conditions. We present the characteristics, PC interventions used, and outcomes of these patients.
  
  
  METHODS
  We conducted a single-center, retrospective, cohort study of LT recipients referred for PC consultation between January 2010 and May 2012. We collected patient demographics, timing and location of PC consultation, PC interventions, and patient outcomes.
  
  
  RESULTS
  Twenty-four patients met the inclusion criteria. Sixteen (67%) had chronic allograft dysfunction. Reasons for referral were dyspnea (42%), end-of-life planning (42%), pain (29%), cough (4%), anxiety (4%), and depression (4%). Referral was made a median of 3.2 (range, 0.2 to 18) years from transplant and a median 14 days (range, 0 to 227 days) from death. Eighty-three percent of consultations occurred >48 hours from time of death. Ninety-two percent of patients were prescribed opioids over their course of treatment. Among the 12 (50%) who died in our center, 10 (83%) were receiving comfort medications. Eight patients (33%) initially requested full resuscitation at the time of PC consultation, but seven of these patients (or their surrogates) later agreed to a do not resuscitate (DNR) order; the eighth was still alive at last follow-up. No patient in this study received cardiopulmonary resuscitation (CPR) at the time of death.
  
  
  CONCLUSIONS
  LT recipients referred for PC co-management typically receive comfort medications and avoid the aggressive end-of-life care usually reported for this population. The effect of PC interventions on patient quality of life requires further study.
authors.affiliation: 1 Division of Respirology, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Rebecca
authors.initials: R
authors.lastname: Colman
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.forename: Reeta
authors.initials: R
authors.lastname: Barua
authors.forename: James
authors.initials: J
authors.lastname: Downar
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome