Is Functional Independence Associated With Improved Long-Term Survival After Lung Transplantation?

Asishana Osho, Michael Mulvihill, Nayan Lamba, Sameer Hirji, Babatunde Yerokun, Muath Bishawi, Philip Spencer, Nikhil Panda, Mauricio Villavicencio, Matthew Hartwig

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: Existing research demonstrates superior short-term outcomes (length of stay, 1-year survival) after lung transplantation in patients with preoperative functional independence. The aim of this study was to determine whether advantages remain significant in the long-term. Methods: The United Network for Organ Sharing database was queried for adult, first-time, isolated lung transplantation records from January 2005 to December 2015. Stratification was performed based on Karnofsky Performance Status Score (3 groups) and on employment at the time of transplantation (2 groups). Kaplan-Meier and Cox analyses were performed to determine the association between these factors and survival in the long-term. Results: Of 16,497 patients meeting criteria, 1,581 (9.6%) were almost completely independent at the time of transplant vs 5,662 (34.3%) who were disabled (completely reliant on others for activities of daily living). Cox models adjusting for recipient, donor, and transplant factors demonstrated a statistically significant association between disability at the time of transplant and long-term death (hazard ratio, 1.26; 95% confidence interval, 1.14 to 1.40; p < 0.001). There were 15,931 patients with available data on paid employment at the time of transplantation. Multivariable analysis demonstrated a statistically significant association between employment at the time of transplantation and death (hazard ratio, 0.86; 95% confidence interval, 0.75 to 0.91; p < 0.001). Conclusions: Preoperative functional independence and maintenance of employment are associated with superior long-term outcomes in lung recipients. The results highlight potential benefits of pretransplant functional rehabilitation for patients on the waiting list for lungs.

Original languageEnglish (US)
Pages (from-to)79-84
Number of pages6
JournalAnnals of Thoracic Surgery
Volume106
Issue number1
DOIs
StatePublished - Jul 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 The Society of Thoracic Surgeons

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