title: Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation.
abstract: BACKGROUND
  The average age of lung transplant recipients is increasing, and the mix of recipient indications for transplantation is changing.
  
  
  OBJECTIVE
  To determine whether the health-related quality-of-life (HRQL) benefit of lung transplantation differs by recipient age and diagnosis.
  
  
  METHODS
  In this prospective cohort study, we obtained serial HRQL measurements in adults with advanced lung disease who subsequently underwent lung transplantation (2004-2012). HRQL assessments included the St. George's Respiratory Questionnaire, 36-Item Short-Form Health Survey (SF-36), EQ-5D, Standard Gamble, and Visual Analog Scale for current health. We used linear mixed effects models for associations between age or diagnosis and changes in HRQL with transplantation. To address potential survivorship bias, we fitted Markov models to the distribution of discrete post-transplant health states (HRQL better than pretransplant, not better, or dead) and estimated quality-adjusted life-years post-transplant.
  
  
  RESULTS
  A total of 430 subjects were listed, 387 were transplanted, and 326 provided both pretransplant and post-transplant data. Transplantation conferred large improvements in all HRQL measures: St. George's change of -47 units (95% confidence interval, -48 to -44), 36-Item Short-Form Health Survey physical component summary score of 17.7 (16.5-18.9), EQ-5D of 0.27 (0.24-0.30), Standard Gamble of 0.48 (0.44-0.51), and Visual Analog of 44 (42-47). Age was not associated with meaningful differences in the HRQL benefits of transplantation. There was less HRQL benefit in interstitial lung disease than in cystic fibrosis.
  
  
  CONCLUSIONS
  Lung transplantation confers large HRQL benefits, which vary by recipient diagnosis, but do not differ substantially in older recipients.
authors.affiliation: 1 Department of Medicine and.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: Lianne G
authors.identifier: http://orcid.org/0000-0002-2693-8676
authors.initials: LG
authors.lastname: Singer
authors.affiliation: 2 University Health Network, Toronto, Ontario, Canada.
authors.forename: Noori A
authors.initials: NA
authors.lastname: Chowdhury
authors.affiliation: 1 Department of Medicine and.|3 St. Michael's Hospital, Toronto, Ontario, Canada; and.|4 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Faughnan
authors.affiliation: 1 Department of Medicine and.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Granton
authors.affiliation: 5 Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: 1 Department of Medicine and.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Marras
authors.affiliation: 1 Department of Medicine and.|3 St. Michael's Hospital, Toronto, Ontario, Canada; and.
authors.forename: D Elizabeth
authors.initials: DE
authors.lastname: Tullis
authors.affiliation: 5 Department of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.affiliation: 1 Department of Medicine and.|2 University Health Network, Toronto, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D017563:Lung Diseases, Interstitial / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
keywords: cystic fibrosis; interstitial lung diseases; obstructive lung diseases; pulmonary hypertension