Extended Long-Term Survival After Lung Transplant: Beyond Fifteen-Years of Follow-Up in a Single Institution
Hunbo Shim, Daniel Rinewalt, Anthony Coppolino, Morgan Harloff, Laura Piechura, Farhang Yazdchi, Mohamed Keshk, John S. Young, Hari Mallidi
Brigham and Women's Hospital, Boston, Massachusetts, United States
Objective: Lung transplant is the only curable treatment option for end-stage lung disease. Although survival is improved after lung transplant, it has not yet attained the same degree of success as other solid-organ transplants. In light of this, there are a limited number of studies with long-term outcomes greater than 15 years. We reviewed these extended long-term patient outcomes of lung transplantation at a single institution.
Methods: We conducted a retrospective cohort study of patients who underwent lung transplant between 1990 and 2005. One hundred and eighty-two patients were categorized into two groups, survivors ≥ 15 years and patients who expired at less than 15 years. Those who underwent concomitant heart and lung transplantation were excluded. Binomial regression analyses were used to examine factors influencing survival of ≥ 15years. Cox proportional hazards models were used to examine mortality in all cases.
Results: The most common indications for transplant were chronic obstructive pulmonary disease (38.5 %), cystic fibrosis (24.7 %) and interstitial pulmonary fibrosis (22.5 %). Overall survival rates at 5, 10, and 15 year were 56.0 ± 3.7%, 29.7 ± 3.4%, and 15.2 ± 2.7%, respectively. The most common cause of death was chronic lung allograft dysfunction (CLAD) (39.5 %), followed by infection (21.4 %), and malignancy (7.1 %). Body mass index (BMI) was significantly lower in survivors ≥ 15years (20.8 ± 3.5 kg/m2) when compared to those who survived < 15 years (24.9 ± 5.1 kg/m2) (p < 0.0001). Age, BMI, cystic fibrosis, and bilateral lung transplants were associated with survival of ≥ 15years in univariable analysis, only decreased BMI was associated with an increased likelihood of survival ≥ 15years in multivariable analysis (OR 0.794, 95% CI 0.693-0.911; p = 0.001) (Table 1). BMI was also inversely associated with long-term mortality (OR 1.054, 95% CI 1.021 - 1.089; p = 0.001), and increasing length of stay after transplant was associated with reduction in the likelihood of overall survival (OR 1.008, 95% CI 1.002 - 1.014; p = 0.014) (Table 2). BMI was a risk factor for development of CLAD (HR 1.050, 95% CI 1.010-1.091; p = 0.013).
Conclusions: Extended survival greater than 15 years may be seen in a small but significant number of patients, with lower BMI being a significant predictor. Our finding suggests increasing BMI affects clinical outcome through development of CLAD.
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