Transplantation |

Gender Disparities in Pulmonary Arterial Hypertension Patients Awaiting Lung Transplant Before and During the Era of the Lung Allocation Score FREE TO VIEW

Kriti Lonial, MD; Alex Balekian, MD
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University of Southern California, Los Angeles, CA

Chest. 2015;148(4_MeetingAbstracts):1080A. doi:10.1378/chest.2281857
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SESSION TITLE: Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Prior studies have reported ethnic disparities in COPD and IPF patients awaiting lung transplants. Although these ethnic disparities narrowed after correcting for socioeconomic status and disappeared after the implementation of the lung allocation score (LAS), the presence of other disparities as well as differences in other lung diseases is unclear. We aimed to describe gender disparities in patients undergoing lung transplant for pulmonary arterial hypertension (PAH).

METHODS: Retrospective review of UNOS lung data for all adult (>18 years) patients with PAH listed for lung transplant between 1987 and 2014. We excluded patients with prior lung transplant. We examined wait list mortality pre-LAS (1987 through April 2005) and post-LAS (May 2005 to 2014). Using Cox proportional hazards, we calculated hazard ratios (HR) for wait list mortality on age, sex, mean pulmonary artery pressure (mPAP), cardiac output (CO), six minute walk distance (6MWD), ethnicity, and insurance status. We also examined the likelihood of undergoing lung transplant by calculating HR for time to transplant on the same variables.

RESULTS: Of the 2335 patients with complete data, 60% were listed pre-LAS and 40% were listed in the era of LAS. Patients tended to be female (68%), with median mPAP 56 mmHg and median CO 4 L/min. 39% of patients underwent transplant, while 18% died on the wait list. Compared to men, women in the pre-LAS era were less likely to undergo lung transplant (HR 0.66, 95%CI [0.53-0.81], p<0.001) after multivariable adjustment; however, women's wait list mortality in the pre-LAS era was lower (HR 0.71, 95%CI [0.53-0.94], p<0.02). After LAS, women's wait list mortality was similar to that of men (HR 0.84, 95%CI [0.59-1.20], p=0.34) after multivariable adjustment; however, they remained less likely to undergo lung transplant (HR 0.63, 95%CI [0.52-0.76], p<0.001).

CONCLUSIONS: Although implementation of the LAS has eliminated differences in wait list survival between men and women, women remain less likely to undergo lung transplant after controlling for other factors.

CLINICAL IMPLICATIONS: Gender disparities in lung transplant for pulmonary hypertension still exist despite attempts at leveling the playing field. The sources of these disparities are unclear.

DISCLOSURE: The following authors have nothing to disclose: Kriti Lonial, Alex Balekian

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