title: Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation.
abstract: Lung transplantation is an accepted and increasingly employed treatment for advanced lung diseases, but the anticipated survival benefit of lung transplantation is poorly understood.
  
  
  
  To determine whether and for which patients lung transplantation confers a survival benefit in the modern era of U.S. lung allocation.
  
  
  
  Data on 13,040 adults listed for lung transplantation between May 2005 and September 2011 were obtained from the United Network for Organ Sharing. A structural nested accelerated failure time model was used to model the survival benefit of lung transplantation over time. The effects of patient, donor, and transplant center characteristics on the relative survival benefit of transplantation were examined.
  
  
  
  Overall, 73.8% of transplant recipients were predicted to achieve a 2-year survival benefit with lung transplantation. The survival benefit of transplantation varied by native disease group (P = 0.062), with 2-year expected benefit in 39.2 and 98.9% of transplants occurring in those with obstructive lung disease and cystic fibrosis, respectively, and by lung allocation score at the time of transplantation (P < 0.001), with net 2-year benefit in only 6.8% of transplants occurring for lung allocation score less than 32.5 and in 99.9% of transplants for lung allocation score exceeding 40.
  
  
  
  A majority of adults undergoing transplantation experience a survival benefit, with the greatest potential benefit in those with higher lung allocation scores or restrictive native lung disease or cystic fibrosis. These results provide novel information to assess the expected benefit of lung transplantation at an individual level and to enhance lung allocation policy.
authors: 1 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: David M
authors: 0000-0002-5459-9579
authors: DM
authors: Vock
authors: 2 Duke Clinical Research Institute and.|3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Michael T
authors: 0000-0002-4186-5698
authors: MT
authors: Durheim
authors: 4 Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Wayne M
authors: WM
authors: Tsuang
authors: 3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: C Ashley
authors: CA
authors: Finlen Copeland
authors: 5 Department of Statistics, North Carolina State University, Raleigh, North Carolina.
authors: Anastasios A
authors: AA
authors: Tsiatis
authors: 5 Department of Statistics, North Carolina State University, Raleigh, North Carolina.
authors: Marie
authors: M
authors: Davidian
authors: 2 Duke Clinical Research Institute and.|6 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and.
authors: Megan L
authors: ML
authors: Neely
authors: 7 Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, New York.
authors: David J
authors: DJ
authors: Lederer
authors: 2 Duke Clinical Research Institute and.|3 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Scott M
authors: SM
authors: Palmer
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D015276:Health Care Rationing / Q000592:standards; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
keywords: lung allocation score; lung transplantation; structural nested accelerated failure time model; survival benefit