Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered

Robert M. Reed, Howard J. Cabral, Mark T. Dransfield, Michael Eberlein, Christian Merlo, Matthew J. Mulligan, Giora Netzer, Pablo G. Sanchez, Steven M. Scharf, Don D. Sin, Bartholome R. Celli

Research output: Contribution to journalArticle

Abstract

Background: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. Methods: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). Results: Median survival in the fourth quartile of BODE score was 59 months (95% CI, 51-77 months) in the UNOS cohort and 37 months (95% CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95% CI, 4.0-5.7; P <.001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95% CI, 4.9-7.6; P <.001). Conclusions: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process.

Original languageEnglish (US)
Pages (from-to)697-701
Number of pages5
JournalChest
Volume153
Issue number3
DOIs
StatePublished - Mar 1 2018

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Dyspnea
Chronic Obstructive Pulmonary Disease
Exercise
Transplants
Lung
Lung Transplantation
Survival
Mortality
Survival Analysis
Comorbidity
Databases

Keywords

  • BODE index
  • COPD
  • lung transplantation
  • prognostication

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Reed, R. M., Cabral, H. J., Dransfield, M. T., Eberlein, M., Merlo, C., Mulligan, M. J., ... Celli, B. R. (2018). Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered. Chest, 153(3), 697-701. https://doi.org/10.1016/j.chest.2017.10.008

Survival of Lung Transplant Candidates With COPD : BODE Score Reconsidered. / Reed, Robert M.; Cabral, Howard J.; Dransfield, Mark T.; Eberlein, Michael; Merlo, Christian; Mulligan, Matthew J.; Netzer, Giora; Sanchez, Pablo G.; Scharf, Steven M.; Sin, Don D.; Celli, Bartholome R.

In: Chest, Vol. 153, No. 3, 01.03.2018, p. 697-701.

Research output: Contribution to journalArticle

Reed, RM, Cabral, HJ, Dransfield, MT, Eberlein, M, Merlo, C, Mulligan, MJ, Netzer, G, Sanchez, PG, Scharf, SM, Sin, DD & Celli, BR 2018, 'Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered', Chest, vol. 153, no. 3, pp. 697-701. https://doi.org/10.1016/j.chest.2017.10.008
Reed RM, Cabral HJ, Dransfield MT, Eberlein M, Merlo C, Mulligan MJ et al. Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered. Chest. 2018 Mar 1;153(3):697-701. https://doi.org/10.1016/j.chest.2017.10.008
Reed, Robert M. ; Cabral, Howard J. ; Dransfield, Mark T. ; Eberlein, Michael ; Merlo, Christian ; Mulligan, Matthew J. ; Netzer, Giora ; Sanchez, Pablo G. ; Scharf, Steven M. ; Sin, Don D. ; Celli, Bartholome R. / Survival of Lung Transplant Candidates With COPD : BODE Score Reconsidered. In: Chest. 2018 ; Vol. 153, No. 3. pp. 697-701.
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abstract = "Background: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. Methods: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). Results: Median survival in the fourth quartile of BODE score was 59 months (95{\%} CI, 51-77 months) in the UNOS cohort and 37 months (95{\%} CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95{\%} CI, 4.0-5.7; P <.001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95{\%} CI, 4.9-7.6; P <.001). Conclusions: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process.",
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AU - Cabral, Howard J.

AU - Dransfield, Mark T.

AU - Eberlein, Michael

AU - Merlo, Christian

AU - Mulligan, Matthew J.

AU - Netzer, Giora

AU - Sanchez, Pablo G.

AU - Scharf, Steven M.

AU - Sin, Don D.

AU - Celli, Bartholome R.

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N2 - Background: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. Methods: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). Results: Median survival in the fourth quartile of BODE score was 59 months (95% CI, 51-77 months) in the UNOS cohort and 37 months (95% CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95% CI, 4.0-5.7; P <.001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95% CI, 4.9-7.6; P <.001). Conclusions: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process.

AB - Background: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. Methods: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). Results: Median survival in the fourth quartile of BODE score was 59 months (95% CI, 51-77 months) in the UNOS cohort and 37 months (95% CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95% CI, 4.0-5.7; P <.001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95% CI, 4.9-7.6; P <.001). Conclusions: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process.

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