Comment évaluer le bénéfice de la transplantation pulmonaire sur la survie des patients ?

Abstract

Several methods have been reported to assess the survival benefit of lung transplantation. Incorrect use of these methods may lead to erroneous conclusions. In most cases, assessment of the survival benefit of lung transplantation relies on the modification of the baseline hazard by lung transplantation, using in most cases the Cox proportional hazard model. However, this method makes stringent assumptions on the relation between pre and post transplant survival. Other methods comparing expected survival without lung transplantation to observed survival after lung transplantation have been developed. We recently described an approach based on the comparison of expected pre and post transplant survival. Methods combining survival as well as functional and quality of life aspects would better describe the whole impact of lung transplantation. The assessment of the survival benefit of lung transplantation now relies on complex statistical methods. None of the proposed methods allow definitive conclusions to be reached on the survival benefit of lung transplantation.