Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD
Author
Timofte, IrinaWijesinha, 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
Date
2020-04-01Journal
ERJ Open ResearchPublisher
European Respiratory SocietyType
Article
Metadata
Show full item recordAbstract
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 rehabilitationLung Transplantation
Pulmonary Disease, Chronic Obstructive
Survival Analysis
Identifier to cite or link to this item
http://hdl.handle.net/10713/16616ae974a485f413a2113503eed53cd6c53
10.1183/23120541.00177-2019
Scopus Count
Collections
Related articles
- National Emphysema Treatment Trial redux: accentuating the positive.
- Authors: Sanchez PG, Kucharczuk JC, Su S, Kaiser LR, Cooper JD
- Issue date: 2010 Sep
- The effects of pulmonary rehabilitation in the national emphysema treatment trial.
- Authors: Ries AL, Make BJ, Lee SM, Krasna MJ, Bartels M, Crouch R, Fishman AP, National Emphysema Treatment Trial Research Group.
- Issue date: 2005 Dec
- Endobronchial Coils Versus Lung Volume Reduction Surgery or Medical Therapy for Treatment of Advanced Homogenous Emphysema.
- Authors: Marchetti N, Kaufman T, Chandra D, Herth FJ, Shah PL, Slebos DJ, Dass C, Bicknell S, Blaas SH, Pfeifer M, Stanzell F, Witt C, Deslee G, Gesierich W, Hetzel M, Kessler R, Leroy S, Hetzel J, Sciurba FC, Criner GJ
- Issue date: 2018 Apr 1
- Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need.
- Authors: Schaffer JM, Singh SK, Reitz BA, Zamanian RT, Mallidi HR
- Issue date: 2015 Mar 3
- The National Emphysema Treatment Trial (NETT): Part I: Lessons learned about emphysema.
- Authors: Criner GJ, Cordova F, Sternberg AL, Martinez FJ
- Issue date: 2011 Oct 1