Abstract
BackgroundAs lung transplantation (LTX) is a valuable treatment procedure for end-stage pulmonary disease, delayed referral to a transplant center should be avoided. We aimed to conduct a single-center analysis of the survival time after listing for LTX and waitlist mortality in each disease category in a Japanese population.MethodsWe included patients listed for LTX at Tohoku University Hospital from January 2007 to December 2020 who were followed up until March 2021. Pulmonary disease was categorized into the Obstructive, Vascular, Suppurative, Fibrosis, and Allogeneic groups. Risk factors for waitlist mortality were assessed using a Cox proportional hazards model. The Kaplan–Meier method was used to model time to death.ResultsWe included 269 LTX candidates. Of those, 100, 72, and 97 patients were transplanted, waiting, and dead, respectively. The median time to LTX and time to death were 796 days (interquartile range [IQR] 579–1056) and 323 days (IQR 129–528), respectively. The Fibrosis group showed the highest mortality (50.9%; p < .001), followed by the Allogeneic (35.0%), Suppurative (33.3%), Vascular (32.1%), and Obstructive (13.1%) groups. The Fibrosis group showed a remarkable risk for waitlist mortality (hazard ratio 3.32, 95% CI 2.11–4.85).ConclusionsIn Japan, the waiting time is extremely long and candidates with Fibrosis have high mortality. There is a need to document outcomes based on the underlying disease for listed LTX candidates to help determine the optimal timing for listing patients based on the estimated local waiting time.
Highlights
As lung transplantation (LTX) is a valuable treatment procedure for end-stage pulmonary disease, delayed referral to a transplant center should be avoided
Overall characteristics of LTX candidates at Tohoku University Hospital Between 2007 and 2020, 1507 patients were registered at Japan Organ Transplant Network (JOTN) for LTX in the whole of Japan [7], of which 277 patients were applied from TUH, 8 were removed afterward and 269 were analyzed (Fig. 1)
Analysis of waitlist mortality and its risk factors in LTX candidates with Fibrosis Risk factors for waitlist mortality in idiopathic pulmonary fibrosis (IPF) were analyzed using a Cox model (Table 4), which revealed that IPF was an independent predictor of death (HR 1.98, 95% CI 1.11–3.55)
Summary
As lung transplantation (LTX) is a valuable treatment procedure for end-stage pulmonary disease, delayed referral to a transplant center should be avoided. We aimed to conduct a single-center analysis of the survival time after listing for LTX and waitlist mortality in each disease category in a Japanese population. Advance in lung transplantation (LTX) has continued to evolve over the last decades and LTX has become a valuable option for selected patients with end-stage pulmonary disease. Given the limited pool of donated organs, optimizing organ allocation to decrease waitlist mortality in patients listed for LTX is needed. The lung allocation score has decreased the mortality rate among individuals on the Hirama et al BMC Pulmonary Medicine (2021) 21:390 waitlist and increased the survival benefit for LTX recipients in the United States [3,4,5]. Based on the current system that urgency is not considered, the waiting time is crucially considered in recipient selection
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