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61 The Association between Poor Socioeconomic Status and Poor Long-Term Outcomes Following Heart Transplantation
S28 Table 1
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011 ●
N Infections Renal Failure Malignancy Bone Abnormalities Diabetes Hypertension Cataracts Obesity TCAD
Octogenarians
60/70 year olds
P-Value
41 36% 54% 58% 39% 32% 77% 17% 17% 37%
82 30% 40% 33% 21% 41% 80% 7% 15% 34%
⫺ 0.64 0.20 0.015 0.06 0.44 0.88 0.17 0.98 0.90
Conclusions: Octogenarian heart transplant recipients have a higher risk of cancer and bone abnormalities compared to heart transplant recipients in their 60-70s. Despite their many medical problems, these patients are survivors for whom natural selection has been kind. 61 The Association between Poor Socioeconomic Status and Poor LongTerm Outcomes Following Heart Transplantation R.R. Davies,1 S.K. Singh,1 M.J. Russo,2 R.C. Robbins,1 P.E. Oyer,1 H.R. Mallidi.1 1Cardiothoracic Surgery, Stanford University, Palo Alto, CA; 2Surgery (Cardiothoracic), University of Chicago, Chicago, IL. Purpose: While race is a risk factor for poor long-term outcomes after heart transplantation, little data exists examining the impact of socioeconomic status. Methods and Materials: We linked data from the UNOS/SRTR 19952009 with 2000 US Census data. A previously validated measure of socioeconomic status (SES) was calculated using 8 census variables for each patient based on zip code and race. Patients were stratified into three groups: low SES (score -30 to -2.1, n ⫽ 10,441), medium SES (score -2.14 to 5.5, n⫽20,874), and high SES (score 5.5 to 23.4, n⫽10,438). Outcomes were compared between groups. Results: Lower SES patients had poorer long-term survival on the waitlist (p ⫽ 0.0014) and were less likely to receive a transplant (p ⬍0.0001). Following transplantation, 30-day mortality was unaffected by SES, but 1-year mortality was higher in the lowSES group (odds ratio 1.14, 95%CI 1.05-1.24). Long-term survival was significantly decreased by lower SES (Figure, p ⬍ 0.0001). Patients in the low SES had a higher incidence of rejection (hazard ratio 1.1, 95%CI 1.0-1.2) and were more likely to be poorly compliant with medications (1.6, 1.3-1.9). In a Cox proportional hazard model, both low SES (hazard ratio 1.4, 95%CI 1.3-1.5) and mid SES (1.1, 1.0-1.2) were associated with decreased long-term survival after transplantation. Cause of graft failure did not differ significantly.
from disadvantaged backgrounds. Improvements in long-term post-transplant care among disadvantaged patients are essential to mitigating striking disparities in outcomes. 62 Barriers to Optimal Palliative Care of Lung Transplant Candidates R.E. Colman,1 R. Curtis,2 J. Nelson,3 J. Barkley,12 A. Beal,4 J. Edelman,13 L. Efferen,5 D. Hadjiliadis,6 D.J. Levine,7 K. Meyer,8 M. Padilla,14 M. Strek,9 B. Varkey,10 K. Wille,11 L.G. Singer.1 1 Department of Medicine, University of Toronto, Toronto, ON, Canada; 2 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center; University of Washington, Seattle, WA; 3Department of Medicine, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY; 4Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, NY; 5 Department of Medicine, Hofstra North Shore- LIJ School of Medicine, Hempstead, NY; 6Division of Pulmonary and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; 7 Division of Pulmonary and Critical Care Medicine and CT Surgery, University of Texas Health Center, San Antonio, TX; 8Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL; 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; 11Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; 12 Carolinas Healthcare System, Charlotte, NC; 13Department of Medicine, University of Washington Medical Center, Seattle, WA; 14 Department of Medicine, Mount Sinai School of Medicine, New York, NY. Purpose: Provision of palliative and end-of-life care is of special importance for patients awaiting lung transplantation. However, lung transplant program practices may be at odds with palliative care principles. We examined perceived barriers to delivery of palliative care to lung transplant candidates and sought strategies to improve such care. Methods and Materials: An anonymized e-mail questionnaire was sent to all members of the American College of Chest Physicians Transplant NetWork and of the Pulmonary Council of the ISHLT. It included demographic and practice-related questions, questions about barriers to palliative care of lung transplant candidates, availability of services and utility of strategies to improve palliative care. Transplant program practitioners were eligible for this study. Results: There were 158 eligible responses. Respondents were in practice 11.3 (⫾9) years. 70% were pulmonologists, 17% surgeons and 13% other care providers, including coordinators and nurse practitioners. Barriers that were considered at least moderate by ⬎50% of respondents were classified as significant. These included unrealistic patient/family expectations about survival until and after transplant, patient/family unwillingness to plan end-of-life care, patient concerns about inappropriate care or abandonment after enrollment in a palliative care program and family disagreements about care goals. Among program policy barriers, the requirement for weight loss or gain was identified. Clinician barriers included competing time demands and seemingly contradictory goals of transplantation and palliative care. Helpful strategies included routine advanced care planning assistance for listed patients, access to palliative care consultants, training of transplant physicians in symptom management and regular meetings between transplant physicians, nurses, patients and families. Conclusions: Clinicians providing care to lung transplant candidates perceive important barriers to the delivery and acceptance of palliative care and believe that there are specific strategies that may improve such care. 63
Conclusions: While early mortality is not affected by SES, long-term mortality is significantly poorer among waitlisted and transplanted patients
Donor Quality of Life in Living-Donor Lobar Lung Transplantation M. Nishioka, C. Yokoyama, M. Inukai, Y. Yamada, C. Suzuki, M. Iwasaki, N. Sunami, T. Oto. Lung Transplant Unit, Okayama University Hospital, Okayama, Japan.
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011 ●
N Infections Renal Failure Malignancy Bone Abnormalities Diabetes Hypertension Cataracts Obesity TCAD
Octogenarians
60/70 year olds
P-Value
41 36% 54% 58% 39% 32% 77% 17% 17% 37%
82 30% 40% 33% 21% 41% 80% 7% 15% 34%
⫺ 0.64 0.20 0.015 0.06 0.44 0.88 0.17 0.98 0.90
Conclusions: Octogenarian heart transplant recipients have a higher risk of cancer and bone abnormalities compared to heart transplant recipients in their 60-70s. Despite their many medical problems, these patients are survivors for whom natural selection has been kind. 61 The Association between Poor Socioeconomic Status and Poor LongTerm Outcomes Following Heart Transplantation R.R. Davies,1 S.K. Singh,1 M.J. Russo,2 R.C. Robbins,1 P.E. Oyer,1 H.R. Mallidi.1 1Cardiothoracic Surgery, Stanford University, Palo Alto, CA; 2Surgery (Cardiothoracic), University of Chicago, Chicago, IL. Purpose: While race is a risk factor for poor long-term outcomes after heart transplantation, little data exists examining the impact of socioeconomic status. Methods and Materials: We linked data from the UNOS/SRTR 19952009 with 2000 US Census data. A previously validated measure of socioeconomic status (SES) was calculated using 8 census variables for each patient based on zip code and race. Patients were stratified into three groups: low SES (score -30 to -2.1, n ⫽ 10,441), medium SES (score -2.14 to 5.5, n⫽20,874), and high SES (score 5.5 to 23.4, n⫽10,438). Outcomes were compared between groups. Results: Lower SES patients had poorer long-term survival on the waitlist (p ⫽ 0.0014) and were less likely to receive a transplant (p ⬍0.0001). Following transplantation, 30-day mortality was unaffected by SES, but 1-year mortality was higher in the lowSES group (odds ratio 1.14, 95%CI 1.05-1.24). Long-term survival was significantly decreased by lower SES (Figure, p ⬍ 0.0001). Patients in the low SES had a higher incidence of rejection (hazard ratio 1.1, 95%CI 1.0-1.2) and were more likely to be poorly compliant with medications (1.6, 1.3-1.9). In a Cox proportional hazard model, both low SES (hazard ratio 1.4, 95%CI 1.3-1.5) and mid SES (1.1, 1.0-1.2) were associated with decreased long-term survival after transplantation. Cause of graft failure did not differ significantly.
from disadvantaged backgrounds. Improvements in long-term post-transplant care among disadvantaged patients are essential to mitigating striking disparities in outcomes. 62 Barriers to Optimal Palliative Care of Lung Transplant Candidates R.E. Colman,1 R. Curtis,2 J. Nelson,3 J. Barkley,12 A. Beal,4 J. Edelman,13 L. Efferen,5 D. Hadjiliadis,6 D.J. Levine,7 K. Meyer,8 M. Padilla,14 M. Strek,9 B. Varkey,10 K. Wille,11 L.G. Singer.1 1 Department of Medicine, University of Toronto, Toronto, ON, Canada; 2 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center; University of Washington, Seattle, WA; 3Department of Medicine, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY; 4Division of Pulmonary and Critical Care Medicine, VA New York Harbor Healthcare System, New York, NY; 5 Department of Medicine, Hofstra North Shore- LIJ School of Medicine, Hempstead, NY; 6Division of Pulmonary and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; 7 Division of Pulmonary and Critical Care Medicine and CT Surgery, University of Texas Health Center, San Antonio, TX; 8Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL; 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; 11Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; 12 Carolinas Healthcare System, Charlotte, NC; 13Department of Medicine, University of Washington Medical Center, Seattle, WA; 14 Department of Medicine, Mount Sinai School of Medicine, New York, NY. Purpose: Provision of palliative and end-of-life care is of special importance for patients awaiting lung transplantation. However, lung transplant program practices may be at odds with palliative care principles. We examined perceived barriers to delivery of palliative care to lung transplant candidates and sought strategies to improve such care. Methods and Materials: An anonymized e-mail questionnaire was sent to all members of the American College of Chest Physicians Transplant NetWork and of the Pulmonary Council of the ISHLT. It included demographic and practice-related questions, questions about barriers to palliative care of lung transplant candidates, availability of services and utility of strategies to improve palliative care. Transplant program practitioners were eligible for this study. Results: There were 158 eligible responses. Respondents were in practice 11.3 (⫾9) years. 70% were pulmonologists, 17% surgeons and 13% other care providers, including coordinators and nurse practitioners. Barriers that were considered at least moderate by ⬎50% of respondents were classified as significant. These included unrealistic patient/family expectations about survival until and after transplant, patient/family unwillingness to plan end-of-life care, patient concerns about inappropriate care or abandonment after enrollment in a palliative care program and family disagreements about care goals. Among program policy barriers, the requirement for weight loss or gain was identified. Clinician barriers included competing time demands and seemingly contradictory goals of transplantation and palliative care. Helpful strategies included routine advanced care planning assistance for listed patients, access to palliative care consultants, training of transplant physicians in symptom management and regular meetings between transplant physicians, nurses, patients and families. Conclusions: Clinicians providing care to lung transplant candidates perceive important barriers to the delivery and acceptance of palliative care and believe that there are specific strategies that may improve such care. 63
Conclusions: While early mortality is not affected by SES, long-term mortality is significantly poorer among waitlisted and transplanted patients
Donor Quality of Life in Living-Donor Lobar Lung Transplantation M. Nishioka, C. Yokoyama, M. Inukai, Y. Yamada, C. Suzuki, M. Iwasaki, N. Sunami, T. Oto. Lung Transplant Unit, Okayama University Hospital, Okayama, Japan.