UNOS DonateLife

May 16, 2001

UNOS Contributes to Two ISHLT Analyses

Leah Bennett, Ph.D., an Assistant Director in the UNOS Research Department, was among the authors of two studies presented at the 21^st Annual Meeting of the International Society for Heart and Lung Transplantation (ISHLT), held April 25-28 in Vancouver, British Columbia.

Factors Affecting Lung Waiting List Mortality

One presentation examined factors affecting the risk of death on the U.S. waiting list for potential lung transplant recipients. A number of diseases and conditions can lead to listing for lung transplants, and the wait list death rates by diagnosis vary significantly.

The four diagnoses studied (idiopathic pulmonary fibrosis, cystic fibrosis, primary pulmonary hypertension and chronic obstructive pulmonary disease) accounted for almost 80 percent of lung listings during the period studied (January 1, 1997 through December 31, 1998). For all the diagnoses studied, patients who were hospitalized or in intensive care at the time of listing had a significantly higher risk of death, but relatively few patients fit into this category.

The researchers identified a number of predictors of wait list deaths that uniquely affected the individual diagnoses; these predictors included clinical factors and measures of blood pressure and lung function. These study results may contribute to allocation policy refinements to reduce lung waiting list deaths.

Thomas Egan, M.D., of the University of North Carolina Hospitals, was the study's first author.

Effect of Immunosuppressive Therapies on Heart Transplant Survival

Another study examined the effect of various combinations of immunosuppressive agents on mortality among U.S. heart transplant recipients. Based on transplants between April 1, 1994 and December 31, 1998, as recorded in the Joint ISHLT/UNOS Thoracic Registry, the three year mortality rates were compared for four specific immunosuppressive regimens used by recipients at the time of hospital discharge.

When compared to the baseline combination of cyclosporine and azathioprine, a combined therapy of tacrolimus and mycophenolate did not significantly improve or diminish the predicted survival rate at three years. The combination of cyclosporine and mycophenolate predicted better survival than the baseline, while a tacrolimus/azathioprine combination predicted lesser survival. These differences essentially disappeared for recipients who remained on the same regimen one year after discharge, although the number of patients receiving tacrolimus was considerably smaller than those receiving cyclosporine.

Jeffrey Hosenpud, M.D., of St. Luke's Medical Center in Milwaukee, was the study's first author.