Featured articleDevelopment of a predictive model for long-term survival after lung transplantation and implications for the lung allocation score
Section snippets
Population
The International Society for Heart and Lung Transplantation (ISHLT) has maintained a registry for lung transplants since 1988. This database is compilation of data from registries around the world including those of the Organ Procurement and Transplantation Network (OPTN). As of June 2008, the registry logged a total of 27,075 lung transplant recipients. Because practices have changed substantially since the first recorded lung transplant, we excluded transplants prior to 1997. In addition, we
Baseline characteristics
Baseline characteristics revealed that the median (interquartile range [IQR]) age of recipients was 54 (42 to 59) years; most recipients were male (53%) and most had COPD (44%; Table 1). Although data on age, gender and diagnosis were complete by design, there was a significant amount of missing data for other variables (Table 1).
Univariate analysis
In comparison to patients with COPD, patients with IPF, other types of fibrosis or pulmonary hypertension were significantly less likely to survive to 5 years, whereas
Discussion
In this study we have suggested that the ability to predict long-term survival with pre-transplant characteristics is poor. In addition, although different covariates were identified among our disease subgroup models, our ability to predict long-term survival was not improved. Finally, the LAS was shown to have a poor ability to predict both 1- and 5-year survival.
Despite multiple modeling approaches, the ability to predict 5-year survival was not much better than chance. There are many
Disclosure statement
Supported by a Transplant Registry Junior Faculty Award of the International Society for Heart and Lung Transplantation (ISHLT) and the National Center for Research Resources (NCRR) from a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research (Grant No. 5KL2RR025015-02).
The authors thank Leah Edwards, PhD for preparing the ISHLT Registry data for analysis, and for her helpful comments regarding the manuscript.
The authors have no conflicts of interest to
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