A Successful Strategy to Maximize Pulmonary Fibrosis (PF) Patient Access, Waiting List (WL) and Post-Lung Transplant (LTx) Survival

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Abstract

PURPOSE: Access to LTx and rates of WL and post-Tx mortality for patients with PF are problematic. We have evolved a strategy to maximize Tx volume and improve survival for PF patients needing LTx. METHODS: From 2012-2018, PF patients were priority assessed, listed and transplanted from a donor pool that included extended and DCD donors. Ex-vivo perfusion was not used. Patients were categorized as experiencing one of two competing events: LTx or WL death. Multivariable competing risk regression were performed for independent predictors of 1-yr post-listing mortality, and failure to reach LTx. RESULTS: From 187 patients listed, 82% (153/187) underwent LTx (median time to Tx, 2.0 mths), while 16% (29/187) died on WL (median time to death, 1.4 mths) Fig. A. Access to LTx for PF was 6.4 per million population (vs. USA = 2.9 p.m.p). Donors were 62% (88/153) extended criteria, including 24% (37/153) DCD. Single LTx was performed in 24% (36/153) of patients. PF comprised 29% (187/644) of all listed and 28% (153/547) of all transplanted patients during the study period. Multivariable predictors of 1-yr mortality from listing were: not receiving a LTx (HR 26, 95% CI 12 - 58, P < 0.0001), inpatient when listed (HR 3.2, 1.5 - 6.9, P = 0.002) and lower PaO2/FiO2 when listed (per 50mmHg less, HR 1.30, 1.04 - 1.63, P = 0.02). Multivariable predictors of failure to reach LTx were: height (per 1cm less, HR 1.11, 1.06-1.16, P<0.0001), blood type O (HR 4.3, 1.9 - 9.3, P < 0.0001) and inpatient when listed (HR 3.9, 1.8-8.5, P = 0.001). Survival after LTx is shown in Fig. B. Single or DCD LTx recipients had similar survival vs. double or DBD recipients (P = 0.6; 0.7). Follow up was 100% complete (mean: 2.5 ± 1.8 yrs). CONCLUSION: Pulmonary fibrosis continues to be presented late and requires a rapid transit to LTx. Use of extended and DCD donor organs facilitate a lower mortality risk than continued waitlist time and enable greater LTx access. Despite challenges, the majority of PF patients can reach LTx with excellent 5-yr survival.

Original languageEnglish
Pages (from-to)S367
Number of pages1
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
Publication statusPublished - 1 Apr 2020
EventAnnual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation 2020 - Montreal, Canada
Duration: 22 Apr 202025 Apr 2020
Conference number: 40th

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