One-year change in the health status predicts the subsequent hospitalization and mortality in patients waitlisted for lung transplantation in Japan

Masaki Ikeda; Yusuke Wakatsuki; Toru Oga; Junko Tokuno; Seiichiro Sugimoto; Megumi Ishihara; Yoshinori Okada; Miki Akiba; Hidenao Kayawake; Satona Tanaka; Yoshito Yamada; Yojiro Yutaka; Akihiro Ohsumi; Daisuke Nakajima; Masatsugu Hamaji; Jumpei Kimura; Toyofumi F Chen-Yoshikawa; Hiroshi Date

doi:10.1016/j.resinv.2023.04.004

One-year change in the health status predicts the subsequent hospitalization and mortality in patients waitlisted for lung transplantation in Japan

Respir Investig. 2023 Jul;61(4):478-484. doi: 10.1016/j.resinv.2023.04.004. Epub 2023 May 15.

Authors

Masaki Ikeda¹, Yusuke Wakatsuki¹, Toru Oga², Junko Tokuno¹, Seiichiro Sugimoto³, Megumi Ishihara³, Yoshinori Okada⁴, Miki Akiba⁵, Hidenao Kayawake¹, Satona Tanaka¹, Yoshito Yamada¹, Yojiro Yutaka¹, Akihiro Ohsumi¹, Daisuke Nakajima¹, Masatsugu Hamaji¹, Jumpei Kimura¹, Toyofumi F Chen-Yoshikawa⁶, Hiroshi Date¹

Affiliations

¹ Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Japan. Electronic address: ogato@med.kawasaki-m.ac.jp.
³ Organ Transplant Center, Okayama University Hospital, Okayama, Japan.
⁴ Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
⁵ Division of Organ Transplantation, Tohoku University Hospital, Sendai, Japan.
⁶ Department of Thoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.

PMID: 37196571
DOI: 10.1016/j.resinv.2023.04.004

Abstract

Background: Poor health-related quality of life (HRQL) at the registration for lung transplantation is related to waitlist mortality. We investigated the relationship between 1-year change in HRQL and subsequent outcomes in patients waitlisted for lung transplantation.

Methods: In a 5-year longitudinal study, we analyzed the factors related to waitlist mortality in 197 lung transplant patients registered on the Japan Organ Transplant Network. HRQL was assessed using St. George's Respiratory Questionnaire (SGRQ), and factors related to changes in SGRQ scores were evaluated after 1 year. We assessed the relationship between the 1-year change in SGRQ score and subsequent mortality or hospitalization.

Results: Among 197 patients, 108 remained waitlisted during the first-year assessment. During the median follow-up period of 469 d, 28 patients died, and 54 underwent lung transplantation. Univariate Cox proportional hazards analysis revealed that the changes in all components and total score of the SGRQ after 1 year were associated with waitlist mortality (p < 0.05). Stepwise multivariate analysis revealed that the 1-year changes in SGRQ scores were significantly related to waitlist mortality. Forty-three patients with worsened HRQL after 1 year had higher likelihoods of hospitalization (p = 0.038) and mortality (p = 0.026) after 1 and 4 years of follow-up, respectively, than 61 patients without worsened HRQL.

Conclusions: Patients with worsened health status during the first year after registration had higher likelihoods of hospitalization and mortality after 1 and 4 years of follow-up, respectively, than those without worsened HRQL. Strategies to improve health status while waiting are needed to reduce waitlist hospitalization or mortality.

Keywords: Health-related quality of life; Lung transplantation; St. George's Respiratory Questionnaire; Waitlist mortality.

MeSH terms

Health Status
Humans
Japan / epidemiology
Longitudinal Studies
Lung Transplantation*
Quality of Life*
Surveys and Questionnaires