J Heart Lung Transplant. 2009 Nov 19. [Epub ahead of print]
Factors Indicative of Long-term Survival After Lung Transplantation: A Review of 836 10-Year Survivors.
Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
INTRODUCTION: Despite 20 years of lung transplantation (LTx), factors influencing long-term survival remain largely unknown. The United Network for Organ Sharing (UNOS) data set provides an opportunity to examine long-term LTx survivors.
METHODS: We conducted a case-control study embedded within the prospectively collected UNOS LTx cohort to identify 836 adults from 1987 to 1997 who survived >/= 10 years after first LTx. LTx patients within the same era and surviving 1 to 5 years served as controls. Multivariable logistic regression with incorporation of spline terms evaluated the odds of being a 10-year survivor. Two separate models were constructed. Model A incorporated pre-operative, operative, and donor-specific factors. Model B incorporated the factors used in Model A with post-operative covariates. Additional outcomes evaluated included hospitalizations for infection, rejection, and bronchiolitis obliterans.
RESULTS: Of 4,818 LTx patients from 1987 to 1997, 836 (17.3%) survived >/= 10 years with a mean follow-up of 148.8 +/- 21.6 months. Mean follow-up for 1,657 controls was 34.0 +/- 13.9 months. The distribution of 10-year survivors by disease was cystic fibrosis, 170 (20%); chronic obstructive pulmonary disease, 254 (30%); and idiopathic pulmonary fibrosis, 92 (11%). On multivariable logistic regression, significant factors influencing 10-year survival included age = 35 years (odds ratio [OR] 1.07, 95% confidence interval [CI], 1.03-1.11; p = 0.01), bilateral LTx (OR. 1.71; 95% CI, 1.25-2.34; p = 0.001), and hospitalizations for infections (OR, 1.40; 95% CI, 1.27-1.54; p < 0.001) and for rejection (OR, 0.55; 95% CI, 0.48-0.65; p < 0.001).
CONCLUSIONS: Examination of a cohort of long-term LTx survivors in the UNOS data set indicates that bilateral LTx and fewer hospitalizations for rejection may portend improved long term-survival after LTx.