Dataset Information

Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.

ABSTRACT: Background:COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established. Methods:We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility criteria and data completeness, 1337 UNOS and 596 NETT patients remained. Kaplan-Meier estimates of transplant-free survival from transplantation for UNOS, and NETT randomisation, were compared between propensity score-matched UNOS (n=401) and NETT (n=262) patients. Results:In propensity-matched analyses, transplanted patients had better survival compared to medically managed patients in NETT (p=0.003). Stratifying on 6?min walk distance (6?MWD) and FEV1, UNOS patients with 6?MWD <1000?ft (?300?m) or FEV1 <20% of predicted had better survival than NETT counterparts (median survival 5.0?years UNOS versus 3.4?years NETT; log-rank p<0.0001), while UNOS patients with 6?MWD ?1000?ft (?300?m) and FEV1 ?20% had similar survival to NETT counterparts (median survival, 5.4?years UNOS versus 4.9?years NETT; log-rank p=0.73), interaction p=0.01. Conclusions:Overall survival is better for matched lung transplant patients compared with medical management alone. Patients who derive maximum benefit are those with 6?MWD <1000?ft (?300?m) or FEV1 <20% of predicted, compared with pulmonary rehabilitation and medical management.

SUBMITTER: Timofte I

PROVIDER: S-EPMC7184114 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.

Timofte Irina I Wijesinha Marniker M Vesselinov Roumen R Kim June J Reed Robert R Sanchez Pablo G PG Ladikos Nicholas N Pham Si S Kon Zachary Z Rajagopal Keshava K Scharf Steven M SM Wise Robert R Sternberg Alice L AL Kaczorowski David D Griffith Bartley B Terrin Michael M Iacono Aldo A

ERJ open research 20200427 2

<h4>Background</h4>COPD patients account for a large proportion of lung transplants; lung transplantation survival benefit for COPD patients is not well established.<h4>Methods</h4>We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) dataset transplanted from May 2005 to August 2016, and 604 patients assigned to receive pulmonary rehabilitation and medical management in the National Emphysema Treatment Trial (NETT). After trimming the populations for NETT eligibility c ...[more]

PMID: 32363207

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Project description:BACKGROUND:Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of pulmonary rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in pulmonary rehabilitation; and, 2) to conduct a process evaluation of the adapted programme. METHODS:The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary rehabilitation sites used the adapted programme, the LWWCOPD programme for pulmonary rehabilitation, to deliver the education component of pulmonary rehabilitation. A process evaluation was conducted: elements included reach (patients' attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients' knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests. RESULTS:The LWWCOPD programme for pulmonary rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30-45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended ? 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients' satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity). CONCLUSION:This rigorous process evaluation has demonstrated that the LWWCOPD programme for pulmonary rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based pulmonary rehabilitation. This programme is now available worldwide (http://www.livingwellwithcopd.com/living-well-and-pulmonary-rehabilitation.html). TRIAL REGISTRATION:This study was registered with clinicaltrials.gov (reference number: NCT01226836).

Dataset Information

Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.

Publications

Survival benefit of lung transplantation compared with medical management and pulmonary rehabilitation for patients with end-stage COPD.

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