Survival of Iranian patients on lung transplant waiting list: is there any difference?

Objective: Lung transplantation is the last treatment option for end-stage pulmonary diseases. Reviewing the characteristics of patients on the lung transplant waiting list is a helpful way to evaluate and prioritize the patients in need of special care. Because we have no information about mortality on the lung transplantation waiting list in Iran, the aim of this study was to evaluate the characteristics and survival rates of these patients.

Methods: The file of lung transplant candidates listed between 2005 and 2010 were evaluated for patient demographic data, type of disorder, waiting list time, and outcomes of death, transplantation, or alive.

Results: The 131 patients on our list in this period revealed a mean age of 37±14 years with 86 (66%) males. The most common disorder among waiting list patients was pulmonary fibrosis (n=52; 40%). Among the 17 (13%) patients who were transplanted, most (35%) suffered from pulmonary fibrosis. The mean waiting time to transplantation was 17.2±11.8 months. Twenty-two patients (7%) died while on the waiting list. The mortality rate was unexpectedly highest among cystic fibrosis patients and then those with bronchiectasis. The mean survival time for all non-transplant patients based on the Kaplan-Meier method was 27.4 months and their 2-year survival rate was 74% based on life tables.

Conclusion: Although pulmonary fibrosis patients show the poorest survival on lung transplant waiting lists, in other countries, patients with cystic fibrosis and bronchiectasis displayed the worst survival on the Iranian list probably due to their poor rehabilitation and sputum evacuation. We concluded that it is necessary for every center to evaluate the characteristics of its patient cohort to match the activity according to the needs.