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    Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD

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    Author
    Timofte, Irina
    Wijesinha, Marniker
    Vesselinov, Roumen
    Kim, June
    Reed, Robert
    Sanchez, Pablo G
    Ladikos, Nicholas
    Pham, Si
    Kon, Zachary
    Rajagopal, Keshava
    Scharf, Steven M
    Wise, Robert
    Sternberg, Alice L
    Kaczorowski, David
    Griffith, Bartley
    Terrin, Michael
    Iacono, Aldo
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    Date
    2020-04-01
    Journal
    ERJ Open Research
    Publisher
    European Respiratory Society
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1183/23120541.00177-2019
    Abstract
    Background: COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established. Methods: We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained. Kaplan–Meier estimates of transplant-free survival from transplantation for UNOS, and NETT randomisation, were compared between propensity score-matched UNOS (n=401) and NETT (n=262) patients. Results: In propensity-matched analyses, transplanted patients had better survival compared to medically managed patients in NETT (p=0.003). Stratifying on 6 min walk distance (6 MWD) and FEV1, UNOS patients with 6 MWD <1000 ft (∼300 m) or FEV1 <20% of predicted had better survival than NETT counterparts (median survival 5.0 years UNOS versus 3.4 years NETT; log-rank p<0.0001), while UNOS patients with 6 MWD ≥1000 ft (∼300 m) and FEV1 ≥20% had similar survival to NETT counterparts (median survival, 5.4 years UNOS versus 4.9 years NETT; log-rank p=0.73), interaction p=0.01. Conclusions: Overall survival is better for matched lung transplant patients compared with medical management alone. Patients who derive maximum benefit are those with 6 MWD <1000 ft (∼300 m) or FEV1 <20% of predicted, compared with pulmonary rehabilitation and medical management.
    Rights/Terms
    Copyright ©ERS 2020.
    Keyword
    pulmonary rehabilitation
    Lung Transplantation
    Pulmonary Disease, Chronic Obstructive
    Survival Analysis
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16616
    ae974a485f413a2113503eed53cd6c53
    10.1183/23120541.00177-2019
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