Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Objectives: To examine long-term survival in patients with idiopathic pulmonary fibrosis (IPF) after the implementation of the lung allocation score (LAS) in single lung transplantation (SLT) and double lung transplantation (DLT) using a national database.
Methods: The United Network for Organ Sharing (UNOS) database was examined for all adult lung transplant recipients in the LAS era (2006-2014). Patients receiving SLT for IPF were compared to those receiving DLT. Survival was examined using Cox proportional hazards analysis and was compared using Kaplan-Meier analysis to calculate post-transplant survival.
Results: A total of 4612 patients with IPF received lung transplants with 2,228 (48.3%) being SLT and 2384 (51.7%) being DLT. The recipient characteristics from the two groups were not significantly different with respect to BMI (27.3 vs. 26.9, p=0.2) and race match (56.6% vs. 54.1%, p=0.08). The recipients of SLT were older (63.1 vs. 57.8 yrs, p<0.003), had lower LAS (43.7 vs. 45.3, p=0.002), lower ischemic time (4.36 vs. 5.63 hrs, p <0.0001), were more likely male (74.2% vs. 70.4%, p<0.003), and more likely to be sex matched (69.7% vs. 65.2%, p=0.001). The donor characteristics were not different with respect to age (34.6 vs 34.5, p=0.77), BMI (25.8 vs. 25.8, p=0.93), and Caucasian race (60.2% vs. 60.1%, p=0.15). The donors of SLT were younger (33.8 vs. 35.5, p=0.0007) and more likely male (59.3% vs. 52.3%, p<0.0001). There was not a difference in acute rejection episodes on index hospitalization (9.7% vs. 8.7%, p=0.23), but SLT patients had a shorter length of stay (20.3 vs. 27.8, p<0.0001). SLT patients had a higher mortality (40.3% vs. 29.6%, p<0.0001) and lower median survival (4.1 yrs vs. 6.4 yrs, p < 0.0001) when compared to DLT patients. On subgroup analysis, patients were risk stratified into quartiles by LAS. The Kaplan-Meier method showed a survival advantage in DLT over SLT across all quartiles (refer to table).
|LAS Quartiles||Median Survival (SLT vs DLT), yrs||p-value|
|Q1 (0 – 36.4)||4.5 vs 7.5||0.007|
|Q2 (36.5-41.4)||4.0 vs 6.6||<0.0001|
|Q3 (41.5-49.6)||3.8 vs 5.5||<0.0001|
|Q4 (49.7-95.2)||2.6 vs 5.1||0.45|
Double lung transplantation appears to offer a survival advantage over single lung transplantation independent of LAS.
To cite this abstract in AMA style:Ambur V, Jayarajan S, Taghavi S, Kadakia S, Lewis C, Furuya Y, Shiose A, Kaiser L, Wheatley G, Guy T, Toyoda Y. Long Term Survival After Single Versus Double Lung Transplantation in Patients With Pulmonary Fibrosis in the Modern Era of the Lung Allocation Score [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-survival-after-single-versus-double-lung-transplantation-in-patients-with-pulmonary-fibrosis-in-the-modern-era-of-the-lung-allocation-score/. Accessed April 4, 2020.
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