PMID- 28131666 OWN - NLM STAT- MEDLINE DCOM- 20180508 LR - 20181113 IS - 1557-3117 (Electronic) IS - 1053-2498 (Print) IS - 1053-2498 (Linking) VI - 36 IP - 7 DP - 2017 Jul TI - The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates. PG - 780-786 LID - S1053-2498(16)30494-6 [pii] LID - 10.1016/j.healun.2016.12.015 [doi] AB - BACKGROUND: The lung allocation score (LAS) has led to improved organ allocation for transplant candidates. At present, the 6-minute walk distance (6MWD) is treated as a binary categorical variable of whether or not a candidate can walk more than 150 feet in 6 minutes. In this study, we tested the hypothesis that 6MWD is presently under-utilized with respect to discriminatory power, and that, as a continuous variable, could better prognosticate risk of waitlist mortality. METHODS: A retrospective cohort analysis was performed using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) transplant database. Candidates listed for isolated lung transplant between May 2005 and December 2011 were included. The population was stratified by 6MWD quartiles and unadjusted survival rates were estimated. Multivariable Cox proportional hazards modeling was used to assess the effect of 6MWD on risk of death. The Scientific Registry of Transplant Recipients (SRTR) Waitlist Risk Model was used to adjust for confounders. The optimal 6MWD for discriminative accuracy in predicting waitlist mortality was assessed by receiver-operating characteristic (ROC) curves. RESULTS: Analysis was performed on 12,298 recipients. Recipients were segregated into quartiles by distance walked. Waitlist mortality decreased as 6MWD increased. In the multivariable model, significant variables included 6MWD, male gender, non-white ethnicity and restrictive lung diseases. ROC curves discriminated 6-month mortality was best at 655 feet. CONCLUSIONS: The 6MWD is a significant predictor of waitlist mortality. A cut-off of 150 feet sub-optimally identifies candidates with increased risk of mortality. A cut-off between 550 and 655 feet is more optimal if 6MWD is to be treated as a dichotomous variable. Utilization of the LAS as a continuous variable could further enhance predictive capabilities. CI - Copyright (c) 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. FAU - Castleberry, Anthony AU - Castleberry A AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. FAU - Mulvihill, Michael S AU - Mulvihill MS AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: mike.mulvihill@dm.duke.edu. FAU - Yerokun, Babatunde A AU - Yerokun BA AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. FAU - Gulack, Brian C AU - Gulack BC AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. FAU - Englum, Brian AU - Englum B AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. FAU - Snyder, Laurie AU - Snyder L AD - Division of Advanced Oncologic and GI Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. FAU - Worni, Mathias AU - Worni M AD - Division of Advanced Oncologic and GI Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, Berne, Switzerland. FAU - Osho, Asishana AU - Osho A AD - Department of General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. FAU - Palmer, Scott AU - Palmer S AD - Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. FAU - Davis, R Duane AU - Davis RD AD - Cardiovascular Institute, Florida Hospital, Orlando, Florida, USA. FAU - Hartwig, Matthew G AU - Hartwig MG AD - Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. LA - eng GR - U01 HL088953/HL/NHLBI NIH HHS/United States GR - UM1 HL088953/HL/NHLBI NIH HHS/United States PT - Journal Article DEP - 20161230 PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 SB - IM MH - Adult MH - Exercise Test MH - *Exercise Tolerance MH - Female MH - Humans MH - Lung Diseases/*mortality/*physiopathology/surgery MH - *Lung Transplantation MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Retrospective Studies MH - Survival Rate MH - *Waiting Lists MH - *Walk Test MH - Walking PMC - PMC5495471 MID - NIHMS867252 OTO - NOTNLM OT - 6-minute walk distance OT - candidate assessment OT - lung transplantation OT - organ allocation OT - waitlist mortality COIS- Disclosure statement The authors have no financial conflicts of interest to disclose. This study was supported by department funding. M.G.H., B.A.Y. and B.C.G. are supported by the Cardiothoracic Trials Network of the National Institutes of Health. EDAT- 2017/01/31 06:00 MHDA- 2018/05/09 06:00 PMCR- 2017/07/03 CRDT- 2017/01/30 06:00 PHST- 2016/04/11 00:00 [received] PHST- 2016/12/16 00:00 [revised] PHST- 2016/12/21 00:00 [accepted] PHST- 2017/01/31 06:00 [pubmed] PHST- 2018/05/09 06:00 [medline] PHST- 2017/01/30 06:00 [entrez] PHST- 2017/07/03 00:00 [pmc-release] AID - S1053-2498(16)30494-6 [pii] AID - 10.1016/j.healun.2016.12.015 [doi] PST - ppublish SO - J Heart Lung Transplant. 2017 Jul;36(7):780-786. doi: 10.1016/j.healun.2016.12.015. Epub 2016 Dec 30.