Our Summary

This research paper looks at patients who were on the list for a lung transplant but improved so much that they no longer needed a transplant. The researchers wanted to understand the characteristics of these patients and what happened to them after they were taken off the list.

They used data from the United Network for Organ Sharing and looked at all adult patients who were listed for a lung transplant between 1987 and 2012. They categorized the patients into three groups: those who got a transplant, those who improved and were taken off the list, and those who got sicker and were taken off the list.

They found that out of 13,688 patients, 12,188 got a transplant, 454 improved and were taken off the list, and 1,046 got sicker and were taken off the list. They also found that those who improved and were taken off the list were more likely to die within 5 years compared to those who got a transplant. However, those who improved had a higher survival rate in the first year after being taken off the list compared to those who got a transplant.

The researchers also found that certain characteristics made it more likely for a patient to improve and be taken off the list. These included being older, being a woman, being listed for primary pulmonary hypertension and retransplantation.

The study also showed that the number of people who improved and were taken off the list decreased after the lung allocation score was implemented. This suggests that the new method of deciding who gets a lung transplant is working better to ensure that the right patients are on the list.

FAQs

  1. What percentage of lung transplant candidates were removed from the transplant list due to improvement in their condition?
  2. What is the survival rate for patients who improved compared to those who underwent a lung transplant?
  3. What factors were found to predict improvement leading to delisting from the lung transplant candidate list?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung transplant is to stay compliant with all medical treatments and appointments, as well as to maintain a healthy lifestyle to optimize the chances of a successful transplant and recovery. It is also important for the patient to communicate any changes in their health or symptoms to their healthcare team promptly.

Suitable For

Patients who are typically recommended for lung transplant are those with end-stage lung disease who have exhausted all other treatment options and have a poor prognosis without a transplant. This includes patients with conditions such as cystic fibrosis, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and primary pulmonary hypertension. Additionally, patients who have undergone a previous lung transplant and are experiencing graft failure may also be considered for retransplantation.

In the study mentioned above, older, female patients listed for primary pulmonary hypertension and retransplantation were more likely to improve to delisting, suggesting that these patients may have a better chance of recovery without the need for a transplant. The study also found that the number of patients improving to delisting decreased after the implementation of the lung allocation score, indicating that the criteria for listing patients for lung transplant may have become more stringent and improved patient appropriateness for transplant.

Overall, lung transplant candidates are typically those who have a high risk of mortality without a transplant and have a good chance of survival and improved quality of life post-transplant. It is important for healthcare providers to carefully evaluate and select patients for lung transplant to ensure the best outcomes for both the patient and the transplant program.

Timeline

Before lung transplant:

  1. Patient is diagnosed with end-stage lung disease.
  2. Patient undergoes evaluation for lung transplant candidacy.
  3. Patient is placed on the lung transplant waiting list.
  4. Patient waits for a suitable donor match.

After lung transplant:

  1. Patient receives a call that a suitable donor organ is available.
  2. Patient undergoes lung transplant surgery.
  3. Patient is monitored closely in the hospital for complications and recovery.
  4. Patient undergoes rehabilitation and physical therapy to regain strength and lung function.
  5. Patient is discharged from the hospital and continues to attend follow-up appointments with their transplant team.
  6. Patient may experience rejection episodes or other complications that require treatment.
  7. Long-term follow-up care is provided to monitor the function of the transplanted lung and overall health.
  8. Patient may experience improved quality of life and increased longevity compared to before the transplant.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a lung transplant surgery?
  2. How long is the recovery process after a lung transplant, and what can I expect during this time?
  3. What medications will I need to take after the transplant, and what are the potential side effects?
  4. How often will I need to follow up with my transplant team after the surgery?
  5. What lifestyle changes will I need to make after the transplant to ensure the best possible outcome?
  6. How successful is the hospital or transplant center in performing lung transplants, and what is their survival rate for patients post-transplant?
  7. What is the average waiting time for a lung transplant at this hospital or transplant center?
  8. What criteria need to be met in order for a patient to be removed from the transplant list due to improvement, and what are the potential outcomes for these patients?
  9. Are there any alternative treatments or therapies that could be considered before pursuing a lung transplant?
  10. How will the lung allocation score impact my likelihood of receiving a transplant, and what changes have been observed in patient outcomes since its implementation?

Reference

Authors: Rudasill SE, Sanaiha Y, Kwon M, Mardock AL, Khoury H, Omari B, Rabkin DG, Benharash P. Journal: Surgery. 2019 Dec;166(6):1142-1147. doi: 10.1016/j.surg.2019.07.009. Epub 2019 Aug 14. PMID: 31421870