JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Mark J. Russo
Ryan R. Davies
Alexander Iribarne
Matthew Bacchetta
Frank D'Ovidio
Joshua R. Sonett
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Russo, M. J.
Right arrow Articles by Sonett, J. R.
PubMed
Right arrow Articles by Russo, M. J.
Right arrow Articles by Sonett, J. R.
Related Collections
Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2009;138:1234-1238
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Who is the high-risk recipient? Predicting mortality after lung transplantation using pretransplant risk factors

Mark J. Russo, MD, MSa,b, Ryan R. Davies, MDa, Kimberly N. Hong, MHSAb, Alexander Iribarne, MDa,b, Steven Kawut, MDc, Matthew Bacchetta, MDa, Frank D'Ovidio, MD, PhDa, Selim Arcasoy, MDc, Joshua R. Sonett, MDa,*

a Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
b International Center for Health Outcomes and Innovation Research (InCHOIR), Columbia University, New York, New York
c Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York

Received for publication July 2, 2008; revisions received November 21, 2008; accepted for publication July 16, 2009.

* Address for reprints: Joshua R. Sonett, MD, New York-Presbyterian Hospital/Columbia, 622 West 168th Street, PH-14 East Room 104, New York, NY 10032. (Email: js2106{at}columbia.edu).

Objectives: The purpose of this study was to create a preoperative risk stratification score (RSS) based on pretransplant recipient characteristics that could be used to predict mortality following lung transplantation.

Methods: United Network for Organ Sharing provided deidentified patient-level data. The study population included 8780 adult recipients (age > 12 years) having lung transplantation from January 1, 1999, to December 31, 2006. Multivariate logistic regression (backward, P > .10) was performed. Using the odds ratio for each identified variable, an RSS was devised. The RSS included only pretransplant recipient variables and excluded donor variables.

Results: The strongest negative predictors of 1-year survival included extracorporeal membrane oxygenation, decreased estimated glomerular filtration rate, total bilirubin >2.0 mg/dL, recipient age, hospitalization at time of transplant, O2 dependence, cardiac index <2, steroid dependence, donor:recipient weight ratio <0.7, all non–cystic fibrosis/chronic obstructive pulmonary disease etiologies, and female donor–to–male recipient. Threshold analysis identified 4 discrete groups: low risk, moderate, elevated risk, and high risk. The 1-year actuarial survival was 80.4% for the entire group, compared with 56.8% in the high-risk group (RSS > 7.2, n = 490; 6%).

Conclusion: Pretransplant recipient variables significantly influence both early and late survival following lung transplantation. Some patients face a higher than average risk of mortality during their first year posttransplant, which challenges the goals of equitable organ allocation. RSS may improve organ allocation strategies by avoiding the potential negative impact of performing transplantation in extremely high-risk candidates.

Abbreviations and Acronyms ALT = alternate list transplant; BMI = body mass index; ECMO = extracorporeal membrane oxygenation; LAS = lung allocation score; OR = odds ratio; ROC = receiver operating characteristic; RSS = risk stratification score; SSLR = stratum-specific likelihood ratio; UNOS = United Network for Organ Sharing






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.