Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.
Journal
ERJ open research
ISSN: 2312-0541
Titre abrégé: ERJ Open Res
Pays: England
ID NLM: 101671641
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
13
10
2019
accepted:
06
02
2020
entrez:
5
5
2020
pubmed:
5
5
2020
medline:
5
5
2020
Statut:
epublish
Résumé
COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established. We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained. Kaplan-Meier estimates of transplant-free survival from transplantation for UNOS, and NETT randomisation, were compared between propensity score-matched UNOS (n=401) and NETT (n=262) patients. In propensity-matched analyses, transplanted patients had better survival compared to medically managed patients in NETT (p=0.003). Stratifying on 6 min walk distance (6 MWD) and FEV Overall survival is better for matched lung transplant patients compared with medical management alone. Patients who derive maximum benefit are those with 6 MWD <1000 ft (∼300 m) or FEV
Sections du résumé
BACKGROUND
BACKGROUND
COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established.
METHODS
METHODS
We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained. Kaplan-Meier estimates of transplant-free survival from transplantation for UNOS, and NETT randomisation, were compared between propensity score-matched UNOS (n=401) and NETT (n=262) patients.
RESULTS
RESULTS
In propensity-matched analyses, transplanted patients had better survival compared to medically managed patients in NETT (p=0.003). Stratifying on 6 min walk distance (6 MWD) and FEV
CONCLUSIONS
CONCLUSIONS
Overall survival is better for matched lung transplant patients compared with medical management alone. Patients who derive maximum benefit are those with 6 MWD <1000 ft (∼300 m) or FEV
Identifiants
pubmed: 32363207
doi: 10.1183/23120541.00177-2019
pii: 00177-2019
pmc: PMC7184114
pii:
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : NIA NIH HHS
ID : T32 AG000262
Pays : United States
Informations de copyright
Copyright ©ERS 2020.
Déclaration de conflit d'intérêts
Conflict of interest: I. Timofte has nothing to disclose. Conflict of interest: M. Wijesinha has nothing to disclose. Conflict of interest: R. Vesselinov has nothing to disclose. Conflict of interest: J. Kim has nothing to disclose. Conflict of interest: R. Reed reports grants from the Dept of Defense and the Flight Attendant Medical Research Institute during the conduct of the study; and grants from the National Institutes of Health, the COPD Foundation, Janssen Research & Development LLC and the University of Maryland Institute for Clinical and Translational Research outside the submitted work. Conflict of interest: P.G. Sanchez has nothing to disclose. Conflict of interest: N. Ladikos has nothing to disclose. Conflict of interest: S. Pham has nothing to disclose. Conflict of interest: Z. Kon reports consulting and speaking fees from Medtronic, Inc., and consulting fees from Breethe, Inc., outside the submitted work. Conflict of interest: K. Rajagopal has nothing to disclose. Conflict of interest: S.M. Scharf has nothing to disclose. Conflict of interest: R. Wise reports grants, and personal fees for data monitoring committees and consulting from AstraZeneca, Medimmune, Pearl and Boehringer Ingelheim; personal fees for a clinical endpoint committee from Contrafect; personal fees for data safety monitoring committees from Pulmonx, Roche, Merck and AbbVie; personal fees for a steering committee from Spiration; personal fees for a workshop and consulting from Sunovion; research grants from Pearl Therapeutics and Sanofi-Aventis; personal fees for consultancy from Circassia, Pneuma, Verona, Mylan/Theravance and Propelleor Health; grants, and personal fees for a data monitoring committee, consultancy, a scientific advisory board and a clinical endpoint committee from GSK, outside the submitted work. Conflict of interest: A.L. Sternberg reports that the NETT was supported by contracts from the NHLBI during the conduct of the study. Conflict of interest: D. Kaczorowski has nothing to disclose. Conflict of interest: B. Griffith has nothing to disclose. Conflict of interest: M. Terrin has nothing to disclose. Conflict of interest: A. Iacono has nothing to disclose.
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