Candidate Selection, Overall Results, and Choosing the Right Operation

ABSTRACT

Lung transplantation offers potential improvement in survival and improved quality of life in patients with end-stage lung disease. International guidelines for candidate selection have been agreed upon to aid physicians and providers in selecting appropriate candidates for lung transplantation. In recent years the U.S. lung allocation score (LAS) has been developed and implemented in an attempt to both maximize utility of scarce donor organs and provide benefit to those in need of lung transplantation. This has helped in the process of offering transplantation to those with the greatest need and best chance of survival. Appropriate lung transplantation candidates should have life-threatening lung disease but remain otherwise healthy, because significant comorbidities may increase the risk of poor outcomes after transplantation limiting long-term survival. Improved outcomes are seen through early referrals to a specialized center and vigilant evaluation to select the most appropriate candidates for lung transplantation.

Lung transplantation - lung allocation score - evaluation - outcomes

REFERENCES

• 1 Reitz B A, Wallwork J L, Hunt S A et al.. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease.  N Engl J Med. 1982;  306 557-564
• 2 Maurer J R, Frost A E, Estenne M, Higenbottam T, Glanville A R. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society.  J Heart Lung Transplant. 1998;  17 703-709
• 3 Orens J B, Estenne M, Arcasoy S Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.  J Heart Lung Transplant. 2006;  25 745-755
• 4 Egan T M, Murray S, Bustami R T et al.. Development of the new lung allocation system in the United States.  Am J Transplant. 2006;  6 1212-1227
• 5 Merlo C A, Weiss E S, Orens J B et al.. Impact of U.S. lung allocation score on survival after lung transplantation.  J Heart Lung Transplant. 2009;  28 769-775
• 6 Hachem R R, Trulock E P. The new lung allocation system and its impact on waitlist characteristics and post-transplant outcomes.  Semin Thorac Cardiovasc Surg. 2008;  20 139-142
• 7 Russo M J, Iribarne A, Hong K N et al.. High lung allocation score is associated with increased morbidity and mortality following transplantation.  Chest. 2009;  , Oct 9. [Epub ahead of print]
• 8 Weiss E S, Merlo C A, Shah A S. Impact of advanced age in lung transplantation: an analysis of United Network for Organ Sharing data.  J Am Coll Surg. 2009;  208 400-409
• 9 Christie J D, Edwards L B, Aurora P et al.. The registry of the international society for heart and lung transplantation: twenty-sixth official adult lung and heart-lung transplantation Report-2009.  J Heart Lung Transplant. 2009;  28 1031-1049
• 10 Kanasky Jr W F, Anton S D, Rodrigue J R, Perri M G, Szwed T, Baz M A. Impact of body weight on long-term survival after lung transplantation.  Chest. 2002;  121 401-406
• 11 Parekh K, Meyers B F, Patterson G A et al.. Outcome of lung transplantation for patients requiring concomitant cardiac surgery.  J Thorac Cardiovasc Surg. 2005;  130 859-863
• 12 Gross C R, Savik K, Bolman III R M, Hertz M I. Long-term health status and quality of life outcomes of lung transplant recipients.  Chest. 1995;  108 1587-1593
• 13 Hosenpud J D, Novick R J, Bennett L E, Keck B M, Fiol B, Daily O P. The Registry of the International Society for Heart and Lung Transplantation: thirteenth official report—1996.  J Heart Lung Transplant. 1996;  15 655-674
• 14 Hosenpud J D, Bennett L E, Keck B M, Edwards E B, Novick R J. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet. 1998;  351 24-27
• 15 Geertsma A, Ten Vergert E M, Bonsel G J, de Boer W J, van der Bij W. Does lung transplantation prolong life? A comparison of survival with and without transplantation.  J Heart Lung Transplant. 1998;  17 511-516
• 16 Charman S C, Sharples L D, McNeil K D, Wallwork J. Assessment of survival benefit after lung transplantation by patient diagnosis.  J Heart Lung Transplant. 2002;  21 226-232
• 17 Connors Jr A F, Dawson N V, Thomas C et al.. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).  Am J Respir Crit Care Med. 1996;  154 959-967
• 18 Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status.  Am J Respir Crit Care Med. 2003;  167 544-549
• 19 Celli B R, Cote C G, Marin J M et al.. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
• 20 Fishman A, Martinez F, Naunheim K National Emphysema Treatment Trial Research Group et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.  N Engl J Med. 2003;  348 2059-2073
• 21 Egan T M, Bennett L E, Garrity E R et al.. Predictors of death on the UNOS lung transplant waiting list: results of a multivariate analysis.  J Heart Lung Transplant. 2001;  20 242
• 22 Aris R M, Gilligan P H, Neuringer I P, Gott K K, Rea J, Yankaskas J R. The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome.  Am J Respir Crit Care Med. 1997;  155 1699-1704
• 23 Dobbin C, Maley M, Harkness J et al.. The impact of pan-resistant bacterial pathogens on survival after lung transplantation in cystic fibrosis: results from a single large referral centre.  J Hosp Infect. 2004;  56 277-282
• 24 Chaparro C, Maurer J, Gutierrez C et al.. Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation.  Am J Respir Crit Care Med. 2001;  163 43-48
• 25 Aris R M, Routh J C, LiPuma J J, Heath D G, Gilligan P H. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: survival linked to genomovar type.  Am J Respir Crit Care Med. 2001;  164 2102-2106
• 26 Bartz R R, Love R B, Leverson G E, Will L R, Welter D L, Meyer K C. Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis.  J Heart Lung Transplant. 2003;  22 433-438
• 27 Egan T M, Detterbeck F C, Mill M R et al.. Long term results of lung transplantation for cystic fibrosis.  Eur J Cardiothorac Surg. 2002;  22 602-609
• 28 Flume P A, Egan T M, Westerman J H et al.. Lung transplantation for mechanically ventilated patients.  J Heart Lung Transplant. 1994;  13 15-21, discussion 22–23
• 29 Massard G, Shennib H, Metras D et al.. Double-lung transplantation in mechanically ventilated patients with cystic fibrosis.  Ann Thorac Surg. 1993;  55 1087-1091, discussion 1091–1092
• 30 Elizur A, Sweet S C, Huddleston C B et al.. Pre-transplant mechanical ventilation increases short-term morbidity and mortality in pediatric patients with cystic fibrosis.  J Heart Lung Transplant. 2007;  26 127-131
• 31 Ellaffi M, Vinsonneau C, Coste J et al.. One-year outcome after severe pulmonary exacerbation in adults with cystic fibrosis.  Am J Respir Crit Care Med. 2005;  171 158-164
• 32 Kerem E, Reisman J, Corey M, Canny G J, Levison H. Prediction of mortality in patients with cystic fibrosis.  N Engl J Med. 1992;  326 1187-1191
• 33 Hadjiliadis D, Madill J, Chaparro C et al.. Incidence and prevalence of diabetes mellitus in patients with cystic fibrosis undergoing lung transplantation before and after lung transplantation.  Clin Transplant. 2005;  19 773-778
• 34 Liou T G, Adler F R, Cox D R, Cahill B C. Lung transplantation and survival in children with cystic fibrosis.  N Engl J Med. 2007;  357 2143-2152
• 35 Fridell J A, Wozniak T C, Reynolds J M et al.. Bilateral sequential lung and simultaneous pancreas transplant: a new approach for the recipient with cystic fibrosis.  J Cyst Fibros. 2008;  7 280-284
• 36 Quattrucci S, Rolla M, Cimino G et al.. Lung transplantation for cystic fibrosis: 6-year follow-up.  J Cyst Fibros. 2005;  4 107-114
• 37 Tschopp O, Boehler A, Speich R et al.. Osteoporosis before lung transplantation: association with low body mass index, but not with underlying disease.  Am J Transplant. 2002;  2 167-172
• 38 Button B M, Roberts S, Kotsimbos T C et al.. Gastroesophageal reflux (symptomatic and silent): a potentially significant problem in patients with cystic fibrosis before and after lung transplantation.  J Heart Lung Transplant. 2005;  24 1522-1529
• 39 Blondeau K, Mertens V, Vanaudenaerde B A et al.. Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection.  Eur Respir J. 2008;  31 707-713
• 40 Barshes N R, DiBardino D J, McKenzie E D et al.. Combined lung and liver transplantation: the United States experience.  Transplantation. 2005;  80 1161-1167
• 41 Knoop C, Vervier I, Thiry P et al.. Cyclosporine pharmacokinetics and dose monitoring after lung transplantation: comparison between cystic fibrosis and other conditions.  Transplantation. 2003;  76 683-688
• 42 Grover F L, Barr M L, Edwards L B et al.. Thoracic transplantation.  Am J Transplant. 2003;  3(Suppl 4) 91-102
• 43 Flaherty K R, Toews G B, Travis W D et al.. Clinical significance of histological classification of idiopathic interstitial pneumonia.  Eur Respir J. 2002;  19 275-283
• 44 Flaherty K R, Mumford J A, Murray S et al.. Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia.  Am J Respir Crit Care Med. 2003;  168 543-548
• 45 Martinez F J, Safrin S, Weycker D IPF Study Group et al. The clinical course of patients with idiopathic pulmonary fibrosis.  Ann Intern Med. 2005;  142 963-967
• 46 Travis W D, Matsui K, Moss J, Ferrans V J. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia.  Am J Surg Pathol. 2000;  24 19-33
• 47 Mogulkoc N, Brutsche M H, Bishop P W, Greaves S M, Horrocks A W, Egan J J. Greater Manchester Pulmonary Fibrosis Consortium . Pulmonary function in idiopathic pulmonary fibrosis and referral for lung transplantation.  Am J Respir Crit Care Med. 2001;  164 103-108
• 48 Katzenstein A L, Fiorelli R F. Nonspecific interstitial pneumonia/fibrosis: histologic features and clinical significance.  Am J Surg Pathol. 1994;  18 136-147
• 49 Flaherty K R, Travis W D, Colby T V et al.. Histopathologic variability in usual and nonspecific interstitial pneumonias.  Am J Respir Crit Care Med. 2001;  164 1722-1727
• 50 Latsi P I, du Bois R M, Nicholson A G et al.. Fibrotic idiopathic interstitial pneumonia: the prognostic value of longitudinal functional trends.  Am J Respir Crit Care Med. 2003;  168 531-537
• 51 Jegal Y, Kim D S, Shim T S et al.. Physiology is a stronger predictor of survival than pathology in fibrotic interstitial pneumonia.  Am J Respir Crit Care Med. 2005;  171 639-644
• 52 D'Alonzo G E, Barst R J, Ayres S M et al.. Survival in patients with primary pulmonary hypertension: results from a national prospective registry.  Ann Intern Med. 1991;  115 343-349
• 53 Barst R J, Rubin L J, Long W A The Primary Pulmonary Hypertension Study Group et al. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension.  N Engl J Med. 1996;  334 296-302
• 54 Channick R N, Simonneau G, Sitbon O et al.. Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study.  Lancet. 2001;  358 1119-1123
• 55 Wilkins M R, Paul G A, Strange J W et al.. Sildenafil versus endothelin receptor antagonist for pulmonary hypertension (SERAPH) study.  Am J Respir Crit Care Med. 2005;  171 1292-1297
• 56 Badesch D B, Tapson V F, McGoon M D et al.. Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease: a randomized, controlled trial.  Ann Intern Med. 2000;  132 425-434
• 57 Kawut S M, Taichman D B, Archer-Chicko C L, Palevsky H I, Kimmel S E. Hemodynamics and survival in patients with pulmonary arterial hypertension related to systemic sclerosis.  Chest. 2003;  123 344-350
• 58 Hopkins W E, Ochoa L L, Richardson G W, Trulock E P. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger syndrome.  J Heart Lung Transplant. 1996;  15 100-105
• 59 McLaughlin V V, Shillington A, Rich S. Survival in primary pulmonary hypertension: the impact of epoprostenol therapy.  Circulation. 2002;  106 1477-1482
• 60 Miyamoto S, Nagaya N, Satoh T et al.. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.  Am J Respir Crit Care Med. 2000;  161 487-492
• 61 Shorr A F, Helman D L, Davies D B, Nathan S D. Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics.  Eur Respir J. 2005;  25 783-788
• 62 Arcasoy S M, Christie J D, Pochettino A et al.. Characteristics and outcomes of patients with sarcoidosis listed for lung transplantation.  Chest. 2001;  120 873-880
• 63 Shorr A F, Davies D B, Nathan S D. Outcomes for patients with sarcoidosis awaiting lung transplantation.  Chest. 2002;  122 233-238
• 64 Kitaichi M, Nishimura K, Itoh H, Izumi T. Pulmonary lymphangioleiomyomatosis: a report of 46 patients including a clinicopathologic study of prognostic factors.  Am J Respir Crit Care Med. 1995;  151 527-533
• 65 Vassallo R, Ryu J H, Schroeder D R, Decker P A, Limper A H. Clinical outcomes of pulmonary Langerhans'-cell histiocytosis in adults.  N Engl J Med. 2002;  346 484-490
• 66 Sundar K M, Gosselin M V, Chung H L, Cahill B C. Pulmonary Langerhans cell histiocytosis: emerging concepts in pathobiology, radiology, and clinical evolution of disease.  Chest. 2003;  123 1673-1683
• 67 Delobbe A, Durieu J, Duhamel A, Wallaert B. Determinants of survival in pulmonary Langerhans' cell granulomatosis (histiocytosis X). Groupe d'Etude en Pathologie Interstitielle de la Société de Pathologie Thoracique du Nord.  Eur Respir J. 1996;  9 2002-2006
• 68 Weiss E S, Allen J G, Merlo C A, Conte J V, Shah A S. Survival after single versus bilateral lung transplantation for high-risk patients with pulmonary fibrosis.  Ann Thorac Surg. 2009;  88 1616-1625, discussion 1625–1626
• 69 Thabut G, Ravaud P, Christie J D et al.. Determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2008;  177 1156-1163
• 70 Gammie J S, Keenan R J, Pham S M et al.. Single- versus double-lung transplantation for pulmonary hypertension.  J Thorac Cardiovasc Surg. 1998;  115 397-402, discussion 402–403