TY - JOUR
T1 - Functional status is highly predictive of outcomes after redo lung transplantation
T2 - An analysis of 390 cases in the modern era
AU - Kilic, Arman
AU - Beaty, Claude A.
AU - Merlo, Christian A.
AU - Conte, John V.
AU - Shah, Ashish S.
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
PY - 2013/11
Y1 - 2013/11
N2 - Background The aim of this study was to evaluate whether functional status is a predictor of outcomes after redo lung transplantation (LTx). Methods Adults undergoing redo LTx after implementation of the Lung Allocation Score (May 2005 to December 2010) were identified in the United Network for Organ Sharing database. Patients were stratified into three groups based on functional status as measured before redo LTx by the Karnofsky scale: (1) no assistance required, (2) some assistance required, and (3) total assistance required. Outcomes after redo LTx were compared based on these preoperative functional cohorts. Results A total of 390 redo LTx were identified: 44 (11%) required no functional assistance, 176 (45%) required some assistance, and 170 (44%) required total assistance preoperatively. Overall survival at 1 year after redo LTx was significantly reduced in the total assistance group (56% versus 82% no assistance, versus 82% some assistance; p < 0.001). After risk adjustment, recipients requiring total assistance preoperatively were at significant risk for 1-year mortality (odds ratio 3.72, p = 0.02). Overall, the preoperative functional assessment outperformed the Lung Allocation Score in predicting 1-year survival after redo LTx (c-index: 0.68 versus 0.58). Transplant survivors who required total assistance before redo LTx were also at increased risk of requiring total assistance after redo LTx (26% versus 0% no assistance, versus 3% some assistance; p < 0.001). Conclusions These data suggest that performing redo LTx in patients requiring total functional assistance is associated with significant risk of early mortality and continued functional limitation, findings that may have important implications in organ allocation.
AB - Background The aim of this study was to evaluate whether functional status is a predictor of outcomes after redo lung transplantation (LTx). Methods Adults undergoing redo LTx after implementation of the Lung Allocation Score (May 2005 to December 2010) were identified in the United Network for Organ Sharing database. Patients were stratified into three groups based on functional status as measured before redo LTx by the Karnofsky scale: (1) no assistance required, (2) some assistance required, and (3) total assistance required. Outcomes after redo LTx were compared based on these preoperative functional cohorts. Results A total of 390 redo LTx were identified: 44 (11%) required no functional assistance, 176 (45%) required some assistance, and 170 (44%) required total assistance preoperatively. Overall survival at 1 year after redo LTx was significantly reduced in the total assistance group (56% versus 82% no assistance, versus 82% some assistance; p < 0.001). After risk adjustment, recipients requiring total assistance preoperatively were at significant risk for 1-year mortality (odds ratio 3.72, p = 0.02). Overall, the preoperative functional assessment outperformed the Lung Allocation Score in predicting 1-year survival after redo LTx (c-index: 0.68 versus 0.58). Transplant survivors who required total assistance before redo LTx were also at increased risk of requiring total assistance after redo LTx (26% versus 0% no assistance, versus 3% some assistance; p < 0.001). Conclusions These data suggest that performing redo LTx in patients requiring total functional assistance is associated with significant risk of early mortality and continued functional limitation, findings that may have important implications in organ allocation.
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U2 - 10.1016/j.athoracsur.2013.05.080
DO - 10.1016/j.athoracsur.2013.05.080
M3 - Article
C2 - 23968759
AN - SCOPUS:84887126018
SN - 0003-4975
VL - 96
SP - 1804
EP - 1811
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -