title: Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis.
abstract: BACKGROUND
  Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patient's transplant-eligible diagnosis and waitlist registration.
  
  
  METHODS
  We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV1] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests.
  
  
  RESULTS
  Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist.
  
  
  CONCLUSIONS
  Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.
authors: Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
authors: Yuan
authors: Y
authors: Liu
authors: Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA; Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA.
authors: Monica
authors: M
authors: Vela
authors: Department of Statistics, University of Chicago, Chicago, Illinois, USA; Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA.
authors: Tanya
authors: T
authors: Rudakevych
authors: Lung Transplant Program, University of Chicago, Chicago, Illinois, USA.
authors: Christopher
authors: C
authors: Wigfield
authors: Lung Transplant Program, University of Chicago, Chicago, Illinois, USA.
authors: Edward
authors: E
authors: Garrity
authors: Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA. Electronic address: msaunders@uchicago.edu.
authors: Milda R
authors: MR
authors: Saunders
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D019458:Insurance Coverage; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014481:United States; D014850:Waiting Lists
keywords: access to healthcare; cystic fibrosis; lung transplant; pulmonary fibrosis; socioeconomic factors; waitlist