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Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database.

Abstract

OBJECTIVE

Lung transplantation has been increasingly applied to patients over the age of 60 years. Importantly, the procedure of choice, single versus bilateral lung transplantation, remains unclear. Therefore, the purpose of this study was to examine short- and midterm outcomes in this age group with particular attention to procedure type.

METHODS

All first lung transplant recipients, 60 years of age or older, reported to the United Network for Organ Sharing from 1998 to 2004 were divided into two groups: bilateral and single lung transplantation. A retrospective review of pertinent baseline characteristics, clinical parameters, and outcomes was performed. Kaplan-Meier methodology was used to estimate and Cox proportional hazards regression modeling was used to compare posttransplant survival between these groups. Additionally, propensity scores analysis was performed.

RESULTS

During the study period, 1656 lung transplant recipients were 60 years of age or older (mean 62.7 +/- 2.4 years, median 62 years). Of these, 364 (28%) had bilateral and 1292 (78%) had single lung transplantation. Survival was not statistically different between the two groups. In the multivariate analysis, bilateral versus single lung transplantation was not a predictor of mortality. Idiopathic pulmonary fibrosis and a donor tobacco history of more than 20 pack-years were significantly associated with mortality (P = .003, CI 1.12-1.76; and P = .006, CI 1.09-1.63; respectively).

CONCLUSIONS

The survival of lung transplant recipients 60 years of age or older who underwent bilateral versus single lung transplantation is comparable. These data suggest that type of procedure is not a predictor of mortality in this age group. Idiopathic pulmonary fibrosis and donor cigarette use of more than 20 pack-years were independently associated with mortality.

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    Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md, USA.

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    Source

    MeSH

    Age Factors
    Aged
    Aged, 80 and over
    Cause of Death
    Cohort Studies
    Female
    Follow-Up Studies
    Graft Rejection
    Graft Survival
    Humans
    Lung Transplantation
    Male
    Middle Aged
    Multivariate Analysis
    Postoperative Complications
    Proportional Hazards Models
    Pulmonary Disease, Chronic Obstructive
    Pulmonary Fibrosis
    Registries
    Risk Assessment
    Survival Analysis
    Time Factors
    Tissue and Organ Procurement
    Treatment Outcome
    United States

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    17258596

    Citation

    Nwakanma, Lois U., et al. "Impact of Bilateral Versus Single Lung Transplantation On Survival in Recipients 60 Years of Age and Older: Analysis of United Network for Organ Sharing Database." The Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 2, 2007, pp. 541-7.
    Nwakanma LU, Simpkins CE, Williams JA, et al. Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database. J Thorac Cardiovasc Surg. 2007;133(2):541-7.
    Nwakanma, L. U., Simpkins, C. E., Williams, J. A., Chang, D. C., Borja, M. C., Conte, J. V., & Shah, A. S. (2007). Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database. The Journal of Thoracic and Cardiovascular Surgery, 133(2), pp. 541-7.
    Nwakanma LU, et al. Impact of Bilateral Versus Single Lung Transplantation On Survival in Recipients 60 Years of Age and Older: Analysis of United Network for Organ Sharing Database. J Thorac Cardiovasc Surg. 2007;133(2):541-7. PubMed PMID: 17258596.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database. AU - Nwakanma,Lois U, AU - Simpkins,Christopher E, AU - Williams,Jason A, AU - Chang,David C, AU - Borja,Marvin C, AU - Conte,John V, AU - Shah,Ashish S, Y1 - 2007/01/10/ PY - 2006/04/28/received PY - 2006/08/25/revised PY - 2006/09/29/accepted PY - 2007/1/30/pubmed PY - 2007/2/24/medline PY - 2007/1/30/entrez SP - 541 EP - 7 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 133 IS - 2 N2 - OBJECTIVE: Lung transplantation has been increasingly applied to patients over the age of 60 years. Importantly, the procedure of choice, single versus bilateral lung transplantation, remains unclear. Therefore, the purpose of this study was to examine short- and midterm outcomes in this age group with particular attention to procedure type. METHODS: All first lung transplant recipients, 60 years of age or older, reported to the United Network for Organ Sharing from 1998 to 2004 were divided into two groups: bilateral and single lung transplantation. A retrospective review of pertinent baseline characteristics, clinical parameters, and outcomes was performed. Kaplan-Meier methodology was used to estimate and Cox proportional hazards regression modeling was used to compare posttransplant survival between these groups. Additionally, propensity scores analysis was performed. RESULTS: During the study period, 1656 lung transplant recipients were 60 years of age or older (mean 62.7 +/- 2.4 years, median 62 years). Of these, 364 (28%) had bilateral and 1292 (78%) had single lung transplantation. Survival was not statistically different between the two groups. In the multivariate analysis, bilateral versus single lung transplantation was not a predictor of mortality. Idiopathic pulmonary fibrosis and a donor tobacco history of more than 20 pack-years were significantly associated with mortality (P = .003, CI 1.12-1.76; and P = .006, CI 1.09-1.63; respectively). CONCLUSIONS: The survival of lung transplant recipients 60 years of age or older who underwent bilateral versus single lung transplantation is comparable. These data suggest that type of procedure is not a predictor of mortality in this age group. Idiopathic pulmonary fibrosis and donor cigarette use of more than 20 pack-years were independently associated with mortality. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/17258596/Impact_of_bilateral_versus_single_lung_transplantation_on_survival_in_recipients_60_years_of_age_and_older:_analysis_of_United_Network_for_Organ_Sharing_database_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)01956-8 DB - PRIME DP - Unbound Medicine ER -