title: Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study.
abstract: Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study from 2010 to 2016, we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-min walk test exercise capacity as predictors of HRQL change. Among 211 initial participants (92% of those eligible), LT improved HRQL by all 5 measures (p < 0.05) and all but SF12-Mental Health improved by threefold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p < 0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net benefits of LT.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: J P
authors.initials: JP
authors.lastname: Singer
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: P P
authors.initials: PP
authors.lastname: Katz
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: A
authors.initials: A
authors.lastname: Soong
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: P
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: D
authors.initials: D
authors.lastname: Huang
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: J
authors.initials: J
authors.lastname: Ho
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: M
authors.initials: M
authors.lastname: Mindo
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: J R
authors.identifier: http://orcid.org/0000-0003-1422-8367
authors.initials: JR
authors.lastname: Greenland
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: S R
authors.initials: SR
authors.lastname: Hays
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: J
authors.initials: J
authors.lastname: Golden
authors.affiliation: Department of Surgery, University of California, San Francisco, CA.
authors.forename: J
authors.initials: J
authors.lastname: Kukreja
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: M E
authors.initials: ME
authors.lastname: Kleinhenz
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shah
authors.affiliation: Department of Medicine, University of California, San Francisco, CA.
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015276:Health Care Rationing; D006801:Humans; D008137:Longitudinal Studies; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: clinical decision-making; clinical research/practice; epidemiology; geriatrics; lung transplantation/pulmonology; organ allocation; quality of life (QOL)