Time to extubation for lung transplant recipients represents a pragmatic end-point to guide the development of prognostic tests

Andrew T Sage; John Peel; Jerome Valero; Jonathan C Yeung; Mingyao Liu; Marcelo Cypel; Beate Sander; Shaf Keshavjee

doi:10.1016/j.healun.2023.06.019

Time to extubation for lung transplant recipients represents a pragmatic end-point to guide the development of prognostic tests

J Heart Lung Transplant. 2023 Nov;42(11):1515-1517. doi: 10.1016/j.healun.2023.06.019. Epub 2023 Jul 3.

Authors

Andrew T Sage¹, John Peel², Jerome Valero³, Jonathan C Yeung¹, Mingyao Liu¹, Marcelo Cypel¹, Beate Sander⁴, Shaf Keshavjee⁵

Affiliations

¹ Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
² Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
³ Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.
⁴ Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁵ Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: shaf.keshavjee@uhn.ca.

PMID: 37406839
DOI: 10.1016/j.healun.2023.06.019

Abstract

The field of transplantation would benefit from the integration of advanced precision medicine techniques. Although predictive tests for lung transplantation require a well-defined clinical end-point, there exists no consensus regarding which outcomes are optimal end-points for these purposes. While many possible candidate end-points exist, we propose that time-to-extubation is an optimal end-point for prognostic tests because of its: clinical relevance; objectiveness; stability over time; and association with healthcare expenditure. Herein, we describe the rationale for this selection and present the limitations of alternative outcomes for this purpose. Using a 72-hour cut-off, time to extubation correlated well with Primary Graft Dysfunction Grade 3, intensive care unit and hospital length of stay, and a greater than 2-fold increase in healthcare cost ratios. Given that time-to-extubation is an objective measure that is readily measured by all lung transplant centers, this metric represents a preferred primary end-point for prognostic tests developed for lung transplantation.

Keywords: costs; end-point selection; lung transplantation; mechanical ventilation; post-transplant outcomes.

MeSH terms

Airway Extubation*
Humans
Length of Stay
Lung
Lung Transplantation* / methods
Prognosis
Retrospective Studies
Transplant Recipients