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

Abstract

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.

Gender differences in long‐term survival post‐transplant: A single‐institution analysis in the lung allocation score era

“…There may also be a selection bias for females who survive to transplant. Sell and colleagues demonstrated that patients (often females) with shorter stature have a 62% higher death or removal rate on the waitlist due to clinical deterioration . Those of short stature that make it to transplant may be better recipients.…”

Lung transplant: the Western Australian experience

“…The three most common indications were ILD (including IPF), CF and COPD (excluding AATD). 7,8 Survival Results from our centre suggest superior survival compared with international registry data. Half of our transplant recipients are over 50 years of age, and 10% were between 60 and 65 years.…”

Contemporary Issues in Lung Transplant Allocation Practices

“…First, patients of short stature (<162 centimeters) have been shown to have a lower rate of transplantation and a higher rate of waitlist death when compared to waitlisted patients of average height in a national registry [20]. Second, patients with a sensitized antibody profile have a longer waitlist time and are less likely to receive a lung transplant [21].…”