title: Outcomes of lung transplant candidates referred for co-management by palliative care: A retrospective case series.
abstract: BACKGROUND
  Lung transplant candidates experience important symptoms, but they are rarely referred for palliative care consultation until they are deemed ineligible for transplant. Our lung transplant service has a high rate of palliative care referral for patients awaiting transplant.
  
  
  OBJECTIVE
  We reviewed the characteristics, interventions, and outcomes of lung transplant candidates referred for co-management by palliative care, to determine whether they safely received opioids and went on to transplantation.
  
  
  METHODS
  Retrospective review of lung transplant candidates referred to our palliative care consultation service between January 2010 and May 2012.
  
  
  RESULTS
  Of 308 lung transplant candidates, 64 (20.7%) were referred to palliative care. Most had interstitial lung disease and were referred for dyspnea and a rapidly deteriorating course. A total of 59 (92%) were prescribed opioids for dyspnea, 55/59 used the opioids more than once, and 38/59 were maintained on standing opioids. There were no episodes of clinically important opioid toxicity or respiratory depression, and there was a trend toward increased exertion during exercise sessions post-opioid versus pre-opioid (19.3 vs 17.0 kcal, respectively, p = 0.06). At last follow-up, 30 (47%) had been transplanted, 23 (36%) had died while on the wait-list, 9 (14%) had died after delisting, and 2 (3%) were still awaiting transplantation. Of the 30 patients who underwent lung transplantation, only 7 (23%) still required an opioid prescription 1 month post-discharge.
  
  
  CONCLUSIONS
  In lung transplant candidates, palliative care and opioids in particular can be safely provided without compromising eligibility for transplantation. Palliative care should not be delayed until a patient is deemed ineligible for transplant.
authors: Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Rebecca
authors: R
authors: Colman
authors: Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.
authors: Lianne G
authors: LG
authors: Singer
authors: Faculty of Medicine, Queen's University, Kingston, ON, Canada.
authors: Reeta
authors: R
authors: Barua
authors: Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada james.downar@utoronto.ca.
authors: James
authors: J
authors: Downar
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019468:Disease Management; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: Organ transplantation; analgesics; chronic obstructive; cystic fibrosis; hypertension; interstitial; lung diseases; opioid; palliative care; pulmonary; pulmonary disease