Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease

John R. Spratt, Roland Z. Brown, Kyle Rudser, Umesh Goswami, Marshall I Hertz, Jagadish R Patil, Irena Cich, Sara J Shumway, Gabriel Loor

Research output: Contribution to journalArticle

Abstract

Background: Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods: Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988−2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results: Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1% underwent single lung transplantation (80.6% for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions: A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.

Original languageEnglish (US)
Pages (from-to)1130-1144
Number of pages15
JournalJournal of Thoracic Disease
Volume11
Issue number4
DOIs
StatePublished - Apr 1 2019

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alpha 1-Antitrypsin Deficiency
Chronic Obstructive Pulmonary Disease
Transplants
Lung
Survival
Lung Transplantation
Pathology
Reoperation
Proportional Hazards Models
Autosomal Recessive alpha-1-Antitrypsin Deficiency
Survival Rate
Hemorrhage
Wounds and Injuries

Keywords

  • Alpha-1-antitrypsin deficiency (A1ATD)
  • Chronic obstructive pulmonary disease (COPD)
  • Lung transplantation
  • Pulmonary disease

Cite this

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title = "Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease",
abstract = "Background: Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods: Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988−2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results: Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1{\%} underwent single lung transplantation (80.6{\%} for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions: A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.",
keywords = "Alpha-1-antitrypsin deficiency (A1ATD), Chronic obstructive pulmonary disease (COPD), Lung transplantation, Pulmonary disease",
author = "Spratt, {John R.} and Brown, {Roland Z.} and Kyle Rudser and Umesh Goswami and Hertz, {Marshall I} and Patil, {Jagadish R} and Irena Cich and Shumway, {Sara J} and Gabriel Loor",
year = "2019",
month = "4",
day = "1",
doi = "10.21037/jtd.2019.04.40",
language = "English (US)",
volume = "11",
pages = "1130--1144",
journal = "Journal of Thoracic Disease",
issn = "2072-1439",
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TY - JOUR

T1 - Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease

AU - Spratt, John R.

AU - Brown, Roland Z.

AU - Rudser, Kyle

AU - Goswami, Umesh

AU - Hertz, Marshall I

AU - Patil, Jagadish R

AU - Cich, Irena

AU - Shumway, Sara J

AU - Loor, Gabriel

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods: Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988−2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results: Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1% underwent single lung transplantation (80.6% for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions: A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.

AB - Background: Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods: Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988−2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results: Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1% underwent single lung transplantation (80.6% for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions: A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.

KW - Alpha-1-antitrypsin deficiency (A1ATD)

KW - Chronic obstructive pulmonary disease (COPD)

KW - Lung transplantation

KW - Pulmonary disease

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U2 - 10.21037/jtd.2019.04.40

DO - 10.21037/jtd.2019.04.40

M3 - Article

VL - 11

SP - 1130

EP - 1144

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 4

ER -