Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan
Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients is mainly based on registration order in Japan. However, scientific evidence for risk stratification for waitlist mortality is needed in future. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.
Using data on 203 patients who were registered as candidates for lung transplantation from deceased donors, we analyzed factors related to waitlist mortality. Dyspnea was evaluated by the modified Medical Research Council (mMRC) dyspnea scale and health status was measured with the St. George’s Respiratory Questionnaire (SGRQ).
Among 197 patients who met inclusion criteria, the main underlying disease was interstitial pneumonia (IP) in 99 patients. During the median follow-up period of 572 days, 72 patients on the waitlist died and 96 received lung transplantation (69 from deceased donor). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total were significantly associated with waitlist mortality (p = 0.003 and p < 0.001). Multivariable competing risk analyses revealed that the mMRC and SGRQ were associated with waitlist mortality, among age, IP, arterial carbon dioxide pressure, and forced vital capacity, which were all significant factors in univariable analyses.
Both mMRC dyspnea and SGRQ were significantly associated with waitlist mortality regardless of patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health should be measured not only from the perspective of multi-dimensional analysis including subjective perceptions, but also as risk stratification for waitlist mortality.
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Multivariable Fine-Gray proportional hazards analysis to analyze the relationship between patient-reported outcomes and mortality in waitlisted patients excluding patients who underwent living-donor lung lobar transplantation after registration.
Scatter plot between the LAS score and mMRC dyspnea is shown.
Scatter plot between the LAS score and SGRQ Total is shown.
Cumulative incidence on the waiting list comparing groups with higher and lower LAS score based on the median score.
Multivariable Fine-Gray proportional hazards analysis to analyze the relationship with mortality between the LAS and patient-reported outcomes in patients waiting for lung transplantation.
Posted 21 Jan, 2021
Received 23 Feb, 2021
On 23 Feb, 2021
On 17 Feb, 2021
Received 13 Feb, 2021
On 29 Jan, 2021
Invitations sent on 28 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 11 Jan, 2021
Patient-reported dyspnea and health predict waitlist mortality in patients waiting for lung transplantation in Japan
Posted 21 Jan, 2021
Received 23 Feb, 2021
On 23 Feb, 2021
On 17 Feb, 2021
Received 13 Feb, 2021
On 29 Jan, 2021
Invitations sent on 28 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 11 Jan, 2021
Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients is mainly based on registration order in Japan. However, scientific evidence for risk stratification for waitlist mortality is needed in future. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.
Using data on 203 patients who were registered as candidates for lung transplantation from deceased donors, we analyzed factors related to waitlist mortality. Dyspnea was evaluated by the modified Medical Research Council (mMRC) dyspnea scale and health status was measured with the St. George’s Respiratory Questionnaire (SGRQ).
Among 197 patients who met inclusion criteria, the main underlying disease was interstitial pneumonia (IP) in 99 patients. During the median follow-up period of 572 days, 72 patients on the waitlist died and 96 received lung transplantation (69 from deceased donor). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total were significantly associated with waitlist mortality (p = 0.003 and p < 0.001). Multivariable competing risk analyses revealed that the mMRC and SGRQ were associated with waitlist mortality, among age, IP, arterial carbon dioxide pressure, and forced vital capacity, which were all significant factors in univariable analyses.
Both mMRC dyspnea and SGRQ were significantly associated with waitlist mortality regardless of patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health should be measured not only from the perspective of multi-dimensional analysis including subjective perceptions, but also as risk stratification for waitlist mortality.
Figure 1
Figure 2