PMID- 37426158
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231023
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 15
IP  - 6
DP  - 2023 Jun 30
TI  - Twenty-year survival following lung transplantation.
PG  - 2997-3012
LID - 10.21037/jtd-22-1414 [doi]
AB  - BACKGROUND: Lung transplantation median survival has seen improvements due to 
      recognition of short-term survival factors but continues to trail behind other 
      solid organs due to limited understanding of long-term survivorship. Given the 
      creation of the United Network for Organ Sharing (UNOS) database in 1986, it was 
      difficult to accrue data on long-term survivors until recently. This study 
      characterizes factors impacting lung transplant survival beyond 20 years, 
      conditional to 1-year survival. METHODS: Lung transplant recipients listed in 
      UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. 
      Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 
      years to identify risk factors associated with long-term outcomes independent of 
      their short-term effects. RESULTS: A total of 6,172 recipients were analyzed, 
      including 472 (7.6%) recipients who lived 20+ years. Factors associated with 
      increased likelihood of 20-year survival were female-to-female gender match, 
      recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) 
      mismatch level 3, and donor cause of death: head trauma. Factors associated with 
      decreased 20-year survival included recipient age >/=55, chronic obstructive 
      pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 
      pack-years, unilateral transplant, blood groups O&AB, recipient glomerular 
      filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min. CONCLUSIONS: This 
      is the first study identifying factors associated with multiple-decade survival 
      following lung transplant in the United States. Despite its challenges, long-term 
      survival is possible and more likely in younger females in good waitlist 
      condition without COPD/E who receive a bilateral allograft from a non-smoking, 
      gender-matched donor of minimal HLA mismatch. Further analysis of the molecular 
      and immunologic implications of these conditions are warranted.
CI  - 2023 Journal of Thoracic Disease. All rights reserved.
FAU - Miggins, John James
AU  - Miggins JJ
AD  - Office of Student Affairs, Baylor College of Medicine, Houston, TX, USA.
FAU - Reul, Ross M Jr
AU  - Reul RM Jr
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Emory University 
      School of Medicine, Atlanta, GA, USA.
FAU - Barrett, Spencer
AU  - Barrett S
AD  - University of Miami, Miami, FL, USA.
FAU - Rana, Abbas
AU  - Rana A
AD  - Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, TX, USA.
FAU - Alnajar, Ahmed
AU  - Alnajar A
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Miami, 
      Miami, FL, USA.
FAU - Dunson, Jordan
AU  - Dunson J
AD  - Department of Orthopaedic Surgery, UT College of Medicine Chattanooga, 
      Chattanooga, TN, USA.
FAU - Shafii, Alexis
AU  - Shafii A
AD  - Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. 
      DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
FAU - Garcha, Puneet
AU  - Garcha P
AD  - Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, 
      Baylor College of Medicine, Houston, TX, USA.
FAU - Goss, John
AU  - Goss J
AD  - Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, 
      Baylor College of Medicine, Houston, TX, USA.
FAU - Loor, Gabriel
AU  - Loor G
AD  - Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. 
      DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20230524
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
CIN - J Thorac Dis. 2023 Aug 31;15(8):4148-4150. PMID: 37691647
CIN - J Thorac Dis. 2023 Sep 28;15(9):4558-4560. PMID: 37868854
CIN - J Thorac Dis. 2023 Sep 28;15(9):4561-4563. PMID: 37868867
PMC - PMC10323557
OTO - NOTNLM
OT  - Long-term survival
OT  - bilateral transplant
OT  - bronchiolitis obliterans
OT  - gender matching
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jtd.amegroups.com/article/view/10.21037/jtd-22-1414/coif). GL serves as a 
      consultant and scientific board advisor for TransMedics and Abiomed Breethe, and 
      he receives research grant support from TransMedics, Abiomed Breethe, AtriCure, 
      and the JLH Foundation. The other authors have no conflicts of interest to 
      declare.
EDAT- 2023/07/10 06:42
MHDA- 2023/07/10 06:43
PMCR- 2023/06/30
CRDT- 2023/07/10 05:06
PHST- 2022/11/10 00:00 [received]
PHST- 2023/03/03 00:00 [accepted]
PHST- 2023/07/10 06:43 [medline]
PHST- 2023/07/10 06:42 [pubmed]
PHST- 2023/07/10 05:06 [entrez]
PHST- 2023/06/30 00:00 [pmc-release]
AID - jtd-15-06-2997 [pii]
AID - 10.21037/jtd-22-1414 [doi]
PST - ppublish
SO  - J Thorac Dis. 2023 Jun 30;15(6):2997-3012. doi: 10.21037/jtd-22-1414. Epub 2023 
      May 24.