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Predictors of lung transplant waitlist mortality for sarcoidosis

Published:October 10, 2022DOI:https://doi.org/10.1016/j.rmed.2022.107008

      Highlights

      • Criteria for lung transplant referral in advanced pulmonary sarcoidosis is not well-established.
      • We attempt to identify potential clinical factors that can precipitate earlier referral for lung transplantation.
      • We evaluated lung transplant waitlist outcomes post implementation of the Lung Allocation Score (LAS) via the SRTR database.
      • Taller minimum donor height and blood type B were found to be protective factors against negative outcomes.
      • Female gender and sever pulmonary hypertension were risk factors for negative waitlist outcomes and may warrant earlier referral for transplantation.

      Abstract

      Rationale

      Unlike in other chronic lung diseases, criteria for lung transplant referral in sarcoidosis is not well-established. Waitlist mortality may offer clues in identifying clinical factors that warrant early referral. We aim to identify predictors for transplant waitlist mortality to improve referral criteria for patients with sarcoidosis.

      Methods

      We conducted a retrospective analysis of 1034 sarcoidosis patients listed for lung transplantation from May 2005 to May 2019 in the Scientific Registry of Transplant Recipients (SRTR) database. All patients were listed after the establishment of the Lung Allocation Score (LAS). We compared patients who died on the transplant waitlist to those who survived to transplantation. Potential predictors of waitlist mortality were assessed utilizing univariate and multivariate analysis performed via logistic regression modeling.

      Results

      Of 1034 candidates listed after LAS implementation, 704 were transplanted and 110 died on the waitlist. Significant predictors of waitlist mortality on multivariate analysis include female gender (OR 2.445; 95% CI 1.513–3.951; p = 0.0003) and severe pulmonary hypertension (OR 1.619; 95% CI 1.067–2.457; p = 0.0236). Taller minimum donor height (OR 0.606; 95% CI 0.379–0.969; p = 0.0365) and blood type B (OR 0.524; 95% CI 0.281–0.975 p = 0.0415) were associated with decreased likelihood of death on the waitlist.

      Conclusion

      Among patients with sarcoidosis on the lung transplant waitlist, taller minimum donor height and blood type B were found to be protective factors against death on the waitlist. Female gender and severe pulmonary hypertension have a higher likelihood of death and earlier referral for transplantation in patients with these characteristics should be considered.

      Keywords

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