Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis

J Heart Lung Transplant. 2017 Mar;36(3):264-271. doi: 10.1016/j.healun.2016.08.016. Epub 2016 Aug 21.

Abstract

Background: Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patient's transplant-eligible diagnosis and waitlist registration.

Methods: We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV1] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests.

Results: Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist.

Conclusions: Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.

Keywords: access to healthcare; cystic fibrosis; lung transplant; pulmonary fibrosis; socioeconomic factors; waitlist.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Adult
  • Cohort Studies
  • Comorbidity
  • Cystic Fibrosis / diagnosis
  • Cystic Fibrosis / mortality
  • Cystic Fibrosis / surgery*
  • Female
  • Graft Rejection
  • Graft Survival
  • Humans
  • Insurance Coverage
  • Kaplan-Meier Estimate
  • Lung Transplantation / methods*
  • Lung Transplantation / mortality
  • Male
  • Middle Aged
  • Patient Selection
  • Pulmonary Fibrosis / diagnosis
  • Pulmonary Fibrosis / mortality
  • Pulmonary Fibrosis / surgery*
  • Referral and Consultation / statistics & numerical data*
  • Respiratory Function Tests
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Survival Analysis
  • United States
  • Waiting Lists*