Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

J Heart Lung Transplant. 2012 Nov;31(11):1182-91. doi: 10.1016/j.healun.2012.07.001. Epub 2012 Aug 11.


Introduction: Although several studies have evaluated risk factors for death after lung transplantation (LTx), few studies have focused on the highest-risk recipients. We undertook this study to evaluate the effect of high lung allocation scores (LAS), ventilator support, and extracorporeal membrane oxygenation (ECMO) support on outcomes after LTx.

Methods: We retrospectively reviewed all LTx recipients in the United Network for Organ Sharing database. Primary stratification was by recipient acuity at the time of LTx. The 3 strata consisted of (1) recipients in the highest LAS quartile (LAS ≥ 48.4), (2) those requiring ventilator support, and (3) those requiring ECMO support. The primary outcome was 1-year mortality. Sub-group analysis focused on temporal trends.

Results: From May 2005 to June 2011, 9,267 adults underwent LTx. Before LTx, 1,874 (20.2%) were in the highest LAS quartile, 526 (5.7%) required ventilator support, and 122 (1.3%) required ECMO support. Unadjusted analysis showed decreased 1-year survival associated with ventilator (67.7%) and ECMO support (57.6%) compared with the highest LAS quartile (81.0%; p < 0.001 for each comparison). These differences persisted on adjusted analysis for ventilator support (hazard ratio, 1.99, p < 0.001) and ECMO support (hazard ratio, 3.03; p < 0.001). Increasing annual center volume was associated with decreased mortality. In patients bridged to LTx with ECMO support, 1-year survival improved over time (coefficient, 8.03% per year; p = 0.06).

Conclusions: High-acuity LTx recipients, particularly those bridged with ventilator or ECMO support, have increased short-term mortality after LTx. However, since the introduction of the LAS, high-risk patients have demonstrated improving outcomes, particularly at high-volume centers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Extracorporeal Membrane Oxygenation
  • Female
  • Hospitals, High-Volume / trends
  • Humans
  • Kaplan-Meier Estimate
  • Lung Diseases / diagnosis
  • Lung Diseases / epidemiology
  • Lung Diseases / surgery*
  • Lung Transplantation / mortality*
  • Lung Transplantation / trends*
  • Male
  • Middle Aged
  • Organ Dysfunction Scores*
  • Proportional Hazards Models
  • Respiration, Artificial
  • Retrospective Studies
  • Severity of Illness Index*
  • Survival Rate
  • Tissue and Organ Procurement / statistics & numerical data*
  • Treatment Outcome
  • United States / epidemiology