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Original article
Patient outcomes from time of listing for lung transplantation in the UK: are there disease-specific differences?
  1. Antonios Kourliouros1,
  2. Rachel Hogg2,
  3. Jenny Mehew2,
  4. Mohamed Al-Aloul3,
  5. Martin Carby4,
  6. James Laurence Lordan5,
  7. Richard Damian Thompson6,
  8. Steven Tsui7,
  9. Jasvir Parmar7
  1. 1Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
  2. 2Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
  3. 3Department of Cardiothoracic Transplantation, Wythenshawe Hospital, Manchester, UK
  4. 4Department of Cardiothoracic Transplantation, Harefield Hospital, Harefield, UK
  5. 5Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
  6. 6Heart and Lung Transplant Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  7. 7Department of Cardiothoracic Transplantation, Royal Papworth NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Antonios Kourliouros, Department of Cardiac Surgery, Royal Brompton Hospital, London SW3 6NP, UK; a.kourliouros{at}rbht.nhs.uk

Abstract

Background The demand for lung transplantation vastly exceeds the availability of donor organs. This translates into long waiting times and high waiting list mortality. We set out to examine factors influencing patient outcomes from the time of listing for lung transplantation in the UK, examining for differences by patient characteristics, lung disease category and transplant centre.

Methods Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant for adult lung-only registrations between 1January 2004 and 31 March 2014. Pretransplant and post-transplant outcomes were evaluated against lung disease category, blood group and height.

Results Of the 2213 patient registrations, COPD comprised 28.4%, pulmonary fibrosis (PF) 26.2%, cystic fibrosis (CF) 25.4% and other lung pathologies 20.1%. The chance of transplantation after listing differed by the combined effect of disease category and centre (p<0.001). At 3 years postregistration, 78% of patients with COPD were transplanted followed by 61% of patients with CF, 59% of other lung pathology patients and 48% of patients with PF, who also had the highest waiting list mortality (37%). The chance of transplantation also differed by height with taller patients having a greater chance of transplant (HR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Patients with blood group O had the highest waiting mortality at 3 years postregistration compared with all other blood groups (27% vs 20%, p<0.001).

Conclusions The way donor lungs were allocated in the UK resulted in discrepancies between the risk profile and probability of lung transplantation. A new donor lung allocation scheme was introduced in 2017 to try to address these shortcomings.

  • lung transplantation

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Footnotes

  • Contributors JP and ST were responsible for the conception and design of the study and its critical review. RH and JM contributed to the design, conduct and statistical analysis of the study. MA-A, MC, JL and RT contributed in the acquisition and interpretation of data, and critical review of the study. AK was responsible for data reporting, drafted the work and revised it to its current format following contribution from all coauthors. All coauthors reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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