J Korean Med Sci.  2022 Oct;37(41):e294. 10.3346/jkms.2022.37.e294.

Outcomes of Patients on the Lung Transplantation Waitlist in Korea: A Korean Network for Organ Sharing Data Analysis

• Yeo HJ
• Oh DK
• Yu WS
• Choi SM
• Jeon K
• Ha M
• Lee JG
• Cho WH
• Kim YT

• KMID: 2534459
• DOI: http://doi.org/10.3346/jkms.2022.37.e294

Abstract

Background
The demand for lung transplants continues to increase in Korea, and donor shortages and waitlist mortality are critical issues. This study aimed to evaluate the factors that affect waitlist outcomes from the time of registration for lung transplantation in Korea.
Methods
Data were obtained from the Korean Network for Organ Sharing for lung-only registrations between September 7, 2009, and December 31, 2020. Post-registration outcomes were evaluated according to the lung disease category, blood group, and age.
Results
Among the 1,671 registered patients, 49.1% had idiopathic pulmonary fibrosis (group C), 37.0% had acute respiratory distress syndrome and other interstitial lung diseases (group D), 7.2% had chronic obstructive pulmonary disease (group A), and 6.6% had primary pulmonary hypertension (group B). Approximately half of the patients (46.1%) were transplanted within 1 year of registration, while 31.8% died without receiving a lung transplant within 1 year of registration. Data from 1,611 patients were used to analyze 1-year postregistration outcomes, which were classified as transplanted (46.1%, n = 743), still awaiting (21.1%, n = 340), removed (0.9%, n = 15), and death on waitlist (31.8%, n = 513). No significant difference was found in the transplantation rate according to the year of registration. However, significant differences occurred between the waitlist mortality rates (P = 0.008) and the still awaiting rates (P = 0.009). The chance of transplantation after listing varies depending on the disease category, blood type, age, and urgency status. Waitlist mortality within 1 year was significantly associated with non-group A disease (hazard ratio [HR], 2.76, P < 0.001), age ≥ 65 years (HR, 1.48, P < 0.001), and status 0 at registration (HR, 2.10, P < 0.001).
Conclusion
Waitlist mortality is still higher in Korea than in other countries. Future revisions to the lung allocation system should take into consideration the high waitlist mortality and donor shortages.

Keyword

Lung Transplant; Waitlist; Mortality; Allocation; Korea

Figure

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  Fig. 1 Patient enrollment. During the study period, 1,671 patients listing for lung transplantation. Of these, 50.0% were transplanted, and 36.6% died while on the waiting list at the time of data extraction.

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  Fig. 2 Cumulative incidence of transplantation and death within 1 year of registration for the overall cohort. The red solid line represents the cumulative incidence of transplantation, and the black dotted line represents the cumulative incidence of death over time.

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  Fig. 3 Cumulative incidence of transplantation by blood group. The possibility of lung transplantation varied significantly among patients with the various blood groups (generalized Wilcoxon test, P < 0.001).

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  Fig. 4 Pre-transplant factors associated with time to transplant. A forest plot shows the HR and 95% CIs associated with variables considered in the multivariate Cox regression analysis. Patients aged < 18 years (HR, 0.66, P = 0.014), those > 65 years (HR, 0.73, P = 0.003), group B disease (HR, 0.33, P < 0.001), group D disease (HR, 0.81, P = 0.011), S0 at registration (HR, 4.73, P < 0.001), S1 at registration (HR, 2.02, P < 0.001), blood type AB (HR, 1.81, P < 0.001) and blood type O (HR, 0.60, P < 0.001) were significantly associated with time to transplantation.HR = hazard ratio, CI = confidence interval.

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  Fig. 5 Pre-transplant factors associated with waitlist mortality. A forest plot shows the HR and 95% CIs associated with variables considered in the multivariate Cox regression analysis. Patients aged > 65 years (HR, 1.48, P < 0.001), status 0 at registration (HR, 2.10, P < 0.001), and patients with group A disease (HR, 0.36, P < 0.001) were significantly associated with waitlist mortality.HR = hazard ratio, CI = confidence interval.

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