CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD

Abstract

SESSION TITLE: Abstracts - Monday Award Semifinalists SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) is a common indication for lung transplantation. Long term survival remains poor following either single or double lung transplantation, and the causes of mortality post transplantation remain unknown. We hypothesized that there would be differences in survival between single and double lung transplantation in COPD. As the residual lung may contribute to outcomes, we also hypothesized that the causes for mortality would be different in single lung transplantation compared with double lung transplantation. METHODS: We analyzed subjects listed in the United Network for Organ Sharing (UNOS) database with primary diagnosis of COPD who received lung transplants after implementation of the Lung Allocation Score (LAS). We excluded subjects who were listed for lung retransplantation or for multiple organ transplant or who were lost to follow-up. Major categories of cause-specific mortality included respiratory, cardiovascular, malignant, non-pulmonary infection, and miscellaneous. Cox proportional hazards analyses were performed to compare all-cause mortality in single vs double lung transplant recipients adjusting for age at transplant, ethnicity, pre-transplant FEV1, pre-transplant 6 minute walk distance, pre-transplant Karnofsky score, and pre-transplant BMI. Similar analyses were performed for cause-specific mortality. RESULTS: We included 4,882 lung transplant recipients; 36.9% were single lung recipients. Mean age was 60.9 years (SD 6.1), 51.7% were male, and 90.6% were white. The median duration of follow-up was 3.0 years (IQR 1.0–5.8). Compared with single lung transplant, receipt of double lung transplant was associated with improved survival (HR 0.81, 95% CI 0.74-0.89;p CONCLUSIONS: Analysis of the UNOS database since implementation of the LAS indicates that likely drivers of mortality differences in single vs. double lung transplant recipients are higher rates of death from respiratory causes and cancer in single lung transplant patients. CLINICAL IMPLICATIONS: Identifying causes of mortality post single and double lung transplant for COPD will enable targeted interventions for these individuals DISCLOSURES: Consultant relationship with NIH Please note: $1001 - $5000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Consulting fee Removed 03/15/2019 by Surya Bhatt, source=Web Response PI relationship with NIH Please note: >$100000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Grant/Research Consultant relationship with Sunovion Please note: $1001 - $5000 Added 03/15/2019 by Surya Bhatt, source=Web Response, value=Consulting fee No relevant relationships by Rachel Naramore, source=Web Response No relevant relationships by Keith Wille, source=Web Response