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Lung Size Mismatch and Survival after Bilateral Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension
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The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
mechanical ventilation or ECMO), donor factors (age, pO2, ischemic time, smoking status, BMI) and transplant factors (center volume, transplant-era), ‘‘oversizing’’ remained associated with improved survival at 1 year (HR 0.19, 95%CI 0.05-0.67, p¼0.009) and 5 years (HR 0.36, 95%CI 0.19-0.70, p¼0.003). Conclusions: Oversizing the allograft is associated with improved F1 survival after BLT for IPAH. 380
Conclusions: Center volume has an impact on patient and graft survival in pediatric lung transplantation. Further detailed risk-factor F1 analysis will help in determining the extent of this impact. 379 Lung Size Mismatch and Survival after Bilateral Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension M. Eberlein,1 C.A. Merlo,2 R.M. Reed.3 1University of Iowa Hospitals and Clinics, Iowa City; 2Johns Hopkins University, Baltimore; 3 University of Maryland, Baltimore. Purpose: Idiopathic pulmonary arterial hypertension (IPAH) is associated with high short-term mortality after bilateral lung transplantation (BLT). We hypothesized that oversizing the allograft is associated with improved survival after BLT for IPAH. Methods and Materials: All adult patients in the UNOS LTx registry who underwent first-time BLT for IPAH between 10/1989-4/2010 were studied. Lung size mismatch was assessed by calculating the predicted total lung capacity (pTLC)ratio(¼pTLCdonor/pTLCrecipient). The cohort was divided evenly into ‘‘undersized’’ (pTLCratioomedian pTLCratio) and ‘‘oversized’’ (pTLCratio4median pTLCratio). Risk of death after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models. Results: The 302 ‘‘undersized’’ patients had a mean pTLCratio of 0.93⫾0.10 compared to 1.24⫾0.14in the 302 ‘‘oversized’’. Cohorts had comparable baseline characteristics. Kaplan Meier curves for 5 year survival are shown in figure 1. Median survival was 831 days longer in the ‘‘oversized’’ cohort (2166vs.1335 days,p¼0.006). In a multivariate model controlling for gender mismatch, recipient factors (age, diabetes, BMI, creatinine), hemodynamics (pulmonary artery systolic pressure, cardiac output), acuity (pretransplant hospitalization, ICU,
Long-Term Results of Transplantation of Normothermic Ex-Vivo Perfused Donor Lungs J.M. Tikkanen, M. Cypel, S. Azad, C.-W. Chow, C. Chaparro, M. Binnie, M. de Perrot, K. Yasufuku, T. Waddell, A. Pierre, S. Keshavjee, L.G. Singer. Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada. Purpose: A steady increase in the number of lung transplantations performed world-wide has led to a shortage in donor lungs. As a result, mortality on the waiting list may be as high as 30-40%. To increase the supply of donor lungs, we have developed normothermic ex-vivo lung perfusion (EVLP) to treat and repair injured donor lungs and increase the number of donor lungs. We have shown previously that the shortterm results with EVLP-treated donor lungs are similar to those of the conventional donor lungs. The aim of this study was to investigate the long-term results of EVLP-donors. Methods and Materials: We studied the survival, development of BOS, and other functional outcomes of lung transplant recipients of either EVLP-treated lungs or conventional donor lungs transplanted in the same center in the same time frame from September 2008 to November 2012. The whole cohort (EVLP n¼56, Controls n¼252) was used for survival analyses while the other analyses were made with patients that were transplanted 3 or more years ago (EVLP n¼18, Controls n¼91). Results: As shown in Figure 1, the survival and freedom from BOS were similar in the two groups. Also, the ratio between the highest FEV1 posttransplant and predicted FEV1 were similar (EVLP 76% ⫾ 30% vs. control 73% ⫾ 24%, P¼NS) as was the mean change between pre- and postoperative 6-minute walking tests (EVLP 181m ⫾ 117m vs. control 213m ⫾ 143m, P¼NS). Conclusions: The recipients of EVLP-treated lung allografts have a similar survival and functional outcome to those patients receiving conventional donor lungs. This suggests that EVLP is an effective and safe method of expanding our donor pool giving us a valuable tool to increase the number of lung transplantations and reduce mortality on the waiting list. F1
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
mechanical ventilation or ECMO), donor factors (age, pO2, ischemic time, smoking status, BMI) and transplant factors (center volume, transplant-era), ‘‘oversizing’’ remained associated with improved survival at 1 year (HR 0.19, 95%CI 0.05-0.67, p¼0.009) and 5 years (HR 0.36, 95%CI 0.19-0.70, p¼0.003). Conclusions: Oversizing the allograft is associated with improved F1 survival after BLT for IPAH. 380
Conclusions: Center volume has an impact on patient and graft survival in pediatric lung transplantation. Further detailed risk-factor F1 analysis will help in determining the extent of this impact. 379 Lung Size Mismatch and Survival after Bilateral Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension M. Eberlein,1 C.A. Merlo,2 R.M. Reed.3 1University of Iowa Hospitals and Clinics, Iowa City; 2Johns Hopkins University, Baltimore; 3 University of Maryland, Baltimore. Purpose: Idiopathic pulmonary arterial hypertension (IPAH) is associated with high short-term mortality after bilateral lung transplantation (BLT). We hypothesized that oversizing the allograft is associated with improved survival after BLT for IPAH. Methods and Materials: All adult patients in the UNOS LTx registry who underwent first-time BLT for IPAH between 10/1989-4/2010 were studied. Lung size mismatch was assessed by calculating the predicted total lung capacity (pTLC)ratio(¼pTLCdonor/pTLCrecipient). The cohort was divided evenly into ‘‘undersized’’ (pTLCratioomedian pTLCratio) and ‘‘oversized’’ (pTLCratio4median pTLCratio). Risk of death after LTx was analyzed using Kaplan-Meier survival and Cox proportional hazards models. Results: The 302 ‘‘undersized’’ patients had a mean pTLCratio of 0.93⫾0.10 compared to 1.24⫾0.14in the 302 ‘‘oversized’’. Cohorts had comparable baseline characteristics. Kaplan Meier curves for 5 year survival are shown in figure 1. Median survival was 831 days longer in the ‘‘oversized’’ cohort (2166vs.1335 days,p¼0.006). In a multivariate model controlling for gender mismatch, recipient factors (age, diabetes, BMI, creatinine), hemodynamics (pulmonary artery systolic pressure, cardiac output), acuity (pretransplant hospitalization, ICU,
Long-Term Results of Transplantation of Normothermic Ex-Vivo Perfused Donor Lungs J.M. Tikkanen, M. Cypel, S. Azad, C.-W. Chow, C. Chaparro, M. Binnie, M. de Perrot, K. Yasufuku, T. Waddell, A. Pierre, S. Keshavjee, L.G. Singer. Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada. Purpose: A steady increase in the number of lung transplantations performed world-wide has led to a shortage in donor lungs. As a result, mortality on the waiting list may be as high as 30-40%. To increase the supply of donor lungs, we have developed normothermic ex-vivo lung perfusion (EVLP) to treat and repair injured donor lungs and increase the number of donor lungs. We have shown previously that the shortterm results with EVLP-treated donor lungs are similar to those of the conventional donor lungs. The aim of this study was to investigate the long-term results of EVLP-donors. Methods and Materials: We studied the survival, development of BOS, and other functional outcomes of lung transplant recipients of either EVLP-treated lungs or conventional donor lungs transplanted in the same center in the same time frame from September 2008 to November 2012. The whole cohort (EVLP n¼56, Controls n¼252) was used for survival analyses while the other analyses were made with patients that were transplanted 3 or more years ago (EVLP n¼18, Controls n¼91). Results: As shown in Figure 1, the survival and freedom from BOS were similar in the two groups. Also, the ratio between the highest FEV1 posttransplant and predicted FEV1 were similar (EVLP 76% ⫾ 30% vs. control 73% ⫾ 24%, P¼NS) as was the mean change between pre- and postoperative 6-minute walking tests (EVLP 181m ⫾ 117m vs. control 213m ⫾ 143m, P¼NS). Conclusions: The recipients of EVLP-treated lung allografts have a similar survival and functional outcome to those patients receiving conventional donor lungs. This suggests that EVLP is an effective and safe method of expanding our donor pool giving us a valuable tool to increase the number of lung transplantations and reduce mortality on the waiting list. F1