title: Short Stature and Access to Lung Transplantation in the United States. A Cohort Study.
abstract: BACKGROUND
  Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates.
  
  
  OBJECTIVE
  To examine the relationship between lung transplant candidate height and waiting list outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year.
  
  
  RESULTS
  The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (<162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation.
  
  
  CONCLUSIONS
  Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.
authors.affiliation: 1 Department of Medicine.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Sell
authors.affiliation: 2 Department of Surgery, and.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.affiliation: 3 Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Goldfarb
authors.affiliation: 4 New York Presbyterian Hospital, New York, New York.
authors.forename: Hanyoung
authors.initials: H
authors.lastname: Park
authors.affiliation: 4 New York Presbyterian Hospital, New York, New York.
authors.forename: Priscilla V
authors.initials: PV
authors.lastname: Heffernan
authors.affiliation: 1 Department of Medicine.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Robbins
authors.affiliation: 1 Department of Medicine.
authors.forename: Lori
authors.initials: L
authors.lastname: Shah
authors.affiliation: 1 Department of Medicine.
authors.forename: Kashif
authors.initials: K
authors.lastname: Raza
authors.affiliation: 2 Department of Surgery, and.
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
authors.affiliation: 2 Department of Surgery, and.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.affiliation: 1 Department of Medicine.
authors.forename: Selim M
authors.initials: SM
authors.lastname: Arcasoy
authors.affiliation: 1 Department of Medicine.|5 Department of Epidemiology, Columbia University Medical Center, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
mesh_terms: D001827:Body Height; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014850:Waiting Lists
keywords: body height; health services accessibility; healthcare disparity; outcome assessment