PURPOSE: COPD is the most common indication for lung transplantation. Appropriate timing of transplantation is challenging in this population, however, as patients may have a protracted clinical course despite high degrees of obstruction. The BODE Index is a simple grading system that has been validated as a predictor of the risk of death in patients with COPD. The aim of this study is to compare survival with lung transplantation to BODE-predicted survival without transplantation for patients with COPD.
METHODS: We performed a retrospective review of 154 patients who underwent lung transplantation for COPD at our institution between 1991 and 2006. Ninety-seven patients met inclusion criteria, and we calculated a BODE Index using pre-transplant variables. Recipient survival was determined using Kaplan-Meier analysis, and comparison with predicted COPD survival at 52 months was performed using Fisher's Exact test.
RESULTS: Of the 97 patients, all BODE scores were in either quartile 3 (n=35) or 4 (n=62). Mean age for this cohort is 57 years, 57% are female, and 5% are African-American. Actual survival with lung transplantation among patients in the BODE 4th quartile was greater than predicted survival without transplantation (53% vs. 20% at 52 months respectively, p=<0.0001). Actual survival with transplantation among patients in the BODE 3rd quartile was not greater than predicted survival without transplantation (54% vs. approximately 60% at 52 months respectively, p=0.70). Survival after transplantation was not significantly different between those in the 3rd and 4th BODE quartiles (p = 0.83).
CONCLUSION: The BODE Index is a useful guide for the appropriate timing of lung transplantation for COPD patients. BODE 4th quartile patients (scores 7-10) demonstrate a survival advantage with lung transplantation. However, transplantation for those with less severe COPD may not result in lengthened survival. Moreover, the natural survival advantage of the BODE 3rd quartile compared to the 4th quartile may be mitigated by transplantation.
CLINICAL IMPLICATIONS: The BODE index may be helpful in selecting appropriate candidates with COPD for lung transplantation.
DISCLOSURE: Jeff Reid, None.