Effect of Lung Transplantation on Health-Related Quality of Life in the Era of the Lung Allocation Score: A U.S. Prospective Cohort Study

Abstract

Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study, from 2010–2016 we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death. We also tested changes in LT-Valued Life Activities disability, BMI, allograft function, and 6-minute walk test exercise capacity as predictors of HRQL change. Amongst 211 initial participants (92% of those eligible), LT improved HRQL by all five measures (p<0.05) and all but SF12-Mental Health improved by three-fold or greater than the minimally clinically important difference. Compared to younger participants, those aged ≥65 improved less in SF12-Physical and Mental Health (p<0.01). Improvements in disability accounted for much of the HRQL improvement. In the LAS era, LT affords meaningful and durable HRQL improvements, mediated by amelioration of disability. Identifying factors limiting HRQL improvement in selected subgroups, especially those aged ≥65, are needed to maximize the net-benefits of LT.

Management and clinical outcomes after lung transplantation in patients with pre‐transplant Mycobacterium abscessus infection: A single center experience

“…The details on this management approach presented in Table may be valuable to other centers considering transplant for patients infected with M abscessus . These strengths are notable since those infected with M abscessus tend to be young patients with CF, a group that generally experiences the greatest survival and HRQL benefit from lung transplantation …”

“…For patients with advanced lung disease from cystic fibrosis (CF), lung transplantation remains the only therapeutic option found to improve survival and health‐related quality of life (HRQL) . However, infection with certain non‐tuberculous mycobacterium (NTM) precludes consideration for transplant at many transplant centers.…”

A novel patient-centered “intention-to-treat” metric of U.S. lung transplant center performance

“…Finally, our study did not consider process measures and other important endpoints, such as disability and quality-of-life. 9 …”

Suicidal ideation in lung transplant recipients: A case series

“…The importance of having available and functional social support to assist with post‐transplant recovery is heavily emphasized in the literature and in clinical settings, yet few studies have examined the impact of social support on psychiatric morbidity after lung transplant. One study found that poorer caregiving supports after lung transplant was associated with an increased risk of patients developing clinically significant depression . In other transplant populations, it has been suggested that limited social support and/or family conflict is linked to poor medical adherence after transplant and several studies have suggested that a large proportion of caregivers of lung recipients report distress associated with adjusting to changing family dynamics, household responsibilities, and job‐related capacities .…”

“…The procedure has been successful at extending many lives. However, despite improvements in physical functioning and overall quality of life among most recipients the prevalence of post‐transplant health complications remains high …”