Impact of Functional Status at the Time of Transplant on Short-Term Pediatric Lung Transplant Outcomes in the USA.

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM Lung Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI:10.1007/s00408-024-00752-9
Wonshill Koh, Huaiyu Zang, Nicholas J Ollberding, Tanya Perry, David Morales, Don Hayes
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Abstract

Purpose: Poor functional status is associated with pediatric lung transplant (LTx) waitlist mortality. We investigate how pre-transplant functional status affects post-LTx survival.

Methods: A retrospective analysis was performed using The United Network for Organ Sharing (UNOS) Registry data. Pediatric first-time lung transplant candidates between ages 1 and 18 years with reported Lansky Play-Performance Scores (LPPS) at the time of waitlist and/or transplant were included from 2005 and 2021. Functional status by the LPPS scores is defined as severe limitation for LPPS score 10-40, mild limitation for LPPS score 50-70, and normal activity for LPPS score 80-100. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were used to assess the impact of functional status on 1-year post-LTx survival.

Results: There were 913 and 610 patients at the time of LTx listing and transplant with LPPS scores, respectively. Poor functional status as determined by the LPPS score at the time of LTx, but not at the time of waitlist, was associated with worse 1-year post-LTx outcome (p value 0.0025 vs. 0.071). Multivariable survival analysis using Cox proportional hazards regression identified that a severely limited functional status at the time of LTx was the most profound risk factor for worse 1-year post-LTx survival outcomes when compared to a normal functional status (HR 2.16; 95% CI 1.15-4.07, p value 0.017).

Conclusions: Children with severely limited functional status at the time of LTx have worse 1-year post-LTx outcome. It is important to develop strategies to optimize the functional status of children for improved post-LTx outcomes.

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移植时的功能状态对美国小儿肺移植短期疗效的影响。
目的:功能状况不佳与小儿肺移植(LTx)候选者死亡率有关。我们研究了移植前的功能状态如何影响肺移植后的存活率:我们利用器官共享联合网络(UNOS)注册数据进行了一项回顾性分析。研究纳入了2005年至2021年期间首次接受肺移植的1至18岁小儿患者,这些患者在等待和/或接受移植时报告了兰斯基运动表现评分(LPPS)。LPPS评分的功能状态定义为:LPPS评分10-40分为严重受限,LPPS评分50-70分为轻度受限,LPPS评分80-100分为正常活动。采用单变量分析、多变量 Cox 回归和 Kaplan-Meier 图评估功能状态对 LTx 术后 1 年生存率的影响:结果:在LTx上市和移植时,分别有913名和610名患者获得了LPPS评分。根据LTx时的LPPS评分确定的不良功能状态与LTx后1年的不良预后有关(P值为0.0025 vs. 0.071),而等待LTx时的不良功能状态与LTx后1年的不良预后无关。使用Cox比例危险回归进行的多变量生存分析表明,与正常功能状态相比,LTx时功能状态严重受限是导致LTx后1年生存结果较差的最重要风险因素(HR 2.16;95% CI 1.15-4.07,P值0.017):结论:接受LTx治疗时功能状态严重受限的儿童LTx术后1年生存率较低。为改善LTx术后预后,制定优化儿童功能状态的策略非常重要。
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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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