PURPOSE: The objectives of lung transplantation (LT) are to prolong survival and improve health-related quality of life (HRQL). The 2005 overhaul of U.S. LT organ allocation to an urgency-based system (Lung Allocation Score [LAS]) resulted in “sicker” patients receiving LT. This change rendered prior data on the impact of LT on HRQL potentially unreliable. Thus, we aimed to evaluate the impact of LT on HRQL in the LAS era.
METHODS: From February-December 2010, patients listed for LT at UCSF completed a telephone-administered survey prior to and 3-months after LT. Respiratory-specific HRQL was quantified with the revised Airways Questionnaire-20 (AQ-20R) (response range 0-20; lower scores denote better HRQL). Generic-HRQL was quantified with the Short Form-12 Physical Component Summary scale (SF12-PCS) (range 0-100; normative population mean 50±10; higher scores denote better HRQL). Changes in HRQL from baseline to 3-months post-transplant were tested with paired t-tests. A ½ standard deviation (SD) change in either instrument was defined as clinically meaningful. We employed linear regression, controlling for age and gender, to test whether pre-LT HRQL predicted post-LT change in HRQL.
RESULTS: 29 subjects completed the pre- and 3-month post-transplant assessments (51% female; mean age 52±16 years). Listing diagnoses included: fibrotic (60%), obstructive (31%), and “other” lung diseases (polymyositis, pulmonary venoocclusive disease, pulmonary hypertension; 3% each). Pre-transplant, subjects had markedly impaired HRQL (AQ20-R=13.4±3; SF12-PCS=18.0±7.8). At 3-months post-transplant, HRQL improved (3-month AQ-20R=3.4±3; SF12-PCS=43.3±8.3) (both p≤0.001 and >3 SD change from baseline). Each ½ SD decrement in pre-transplant HRQL predicted post-transplant improvements of 2.5 points in respiratory-specific HRQL (AQ-20R: -2.5, 95% CI: -3.4 to -1.5) and 6 points in generic-HRQL (SF12-PCS: 5.9, 95% CI: 3.4 to 8.5) (both p<0.0005).
CONCLUSIONS: In the LAS era, LT achieves its objective of improving HRQL by a clinically meaningful difference by 3 months post-transplant. Further, those with the most compromised HRQL pre-transplant derive the greatest transplant benefit.
CLINICAL IMPLICATIONS: These findings may be relevant for pre-transplant counseling as well as future models of lung allocation that aim to maximize “net lung transplant benefit”.
DISCLOSURE: The following authors have nothing to disclose: Jonathan Singer, Patricia Katz, Hubert Chen, Tyler Phelan, Todd Golden, Lorriana Leard, Jasleen Kukreja, Paul Blanc
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