Lung Transplant Waitlist Mortality: Height as a Predictor of Poor Outcomes

Keeshan, Britton; Rossano, Joseph W.; Beck, Nicole; Hammond, Rachel; Kreindler, James L.; Spray, Thomas L.; Fuller, Stephanie; Goldfarb, Samuel

doi:10.1016/j.healun.2014.01.291

Cited by 31 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Together these data suggest that the differences in outcomes we observed between short and taller adults are a disparity, which the World Health Organization defines as a "differences in health that are not only unnecessary and avoidable, but in addition, are considered unfair and unjust." (14,15) Although shorter height has been previously shown to be associated with a higher rate of death among pediatric lung transplant candidates (9), there has been little formal examination of the impact of candidate height on outcomes before and after lung transplantation. Registry reports from the International Society for Heart and Lung Transplantation do not examine waiting list outcomes, and therefore have not identified short stature as a risk factor for poor outcomes (16).…”

Section: Discussionmentioning

confidence: 99%

“…Third, we have not demonstrated that implementation of changes in allocation policy or transplant center practices would result in improved outcomes for those of shorter stature. Finally, we did not include pediatric lung transplant candidates in our study because they have been examined previously (9).…”

Section: Discussionmentioning

confidence: 99%

“…We have anecdotally noted that short lung transplant candidates seem to have longer waiting times than taller candidates, perhaps related to the common practice of attempting to find donor lungs of similar size to the candidate. Recently, shorter height was found to be a predictor of higher waiting list mortality in pediatric lung transplant candidates (9).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates.Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes.Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results:The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (,162 cm) and 202.0 per 100 person-years among candidates of average stature (170-176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29-39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24-96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10-85%) higher rate of respiratory failure while awaiting lung transplantation.Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

Sell¹,

Bacchetta²,

Goldfarb

et al. 2016

Am J Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…A recent retrospective analysis of the UNOS database performed since the implementation of the LAS (between May 2005 and June 2013) reveals that adults account for >96% (16 301) of all patients listed for lung transplant, with 72% (11 682) ultimately receiving a transplant, 14% (2350) adult patients died or were removed from the waitlist for becoming too sick to transplant, and 8% (1224) remained active. There were 672 pediatric (<18 yr old) patients listed for lung transplant in the same time period, 58% (388) were transplanted, 22% (148) died or were removed from listing for being too sick, 12% (83) were removed for other reasons, and 8% (53) remained active.…”

Section: Las and Waitlist Mortalitymentioning

confidence: 99%

The evolving potential for pediatric ex vivo lung perfusion

Luc

Nagendran

2015

Pediatric Transplantation

View full text Add to dashboard Cite

Despite the rise in the number of adult lung transplantations performed, rates of pediatric lung transplantation remain low. Lung transplantation is an accepted therapy for pediatric end-stage lung disease; however, it is limited by a shortage of donor organs. EVLP has emerged as a platform for assessment and preservation of donor lung function. EVLP has been adopted in adult lung transplantation and has successfully led to increased adult lung transplantations and donor lung utilization. We discuss the future implications of EVLP utilization, specifically, its potential evolving role in overcoming donor shortages in smaller children and adolescents to improve the quality and outcomes of lung transplantation in pediatric patients.

show abstract

“…The large majority of donor lungs are rejected due to injuries sustained during complications of brain death and intensive care. The consequence is that wait-list mortality can be as high as 15-25 % [2].…”

Section: Introductionmentioning

confidence: 99%