Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered

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

doi:10.1016/j.chest.2017.10.008

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Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered

Journal article

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Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered

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

Chest, Vol.153(3), pp.697-701

03/2018

DOI: 10.1016/j.chest.2017.10.008

PMCID: PMC5989634

PMID: 29054348

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Abstract

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. 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). 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). 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.

BODE index

lung transplantation

prognostication

COPD

Details

Title: Subtitle: Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered
Creators: Robert M Reed - University of Maryland School of Medicine, Baltimore, MD. Electronic address: rreed@som.umaryland.edu
Howard J Cabral - Boston University School of Public Health, Boston, MA
Mark T Dransfield - University of Alabama School of Medicine, Birmingham, AL
Michael Eberlein - University of Iowa School of Medicine, Iowa City, IA
Christian A Merlo - Johns Hopkins University School of Medicine, Baltimore, MD
Matthew J Mulligan - University of Utah School of Medicine, Salt Lake City, UT
Giora Netzer - University of Maryland School of Medicine, Baltimore, MD
Pablo G Sanchez - University of Pittsburgh School of Medicine, Pittsburgh, PA
Steven M Scharf - University of Maryland School of Medicine, Baltimore, MD
Don D Sin - University of British Columbia Respiratory Medicine, Vancouver, BC, Canada
Bartholome R Celli - Department of Medicine, Brigham and Women's Hospital, Boston, MA
Resource Type: Journal article
Publication Details: Chest, Vol.153(3), pp.697-701
DOI: 10.1016/j.chest.2017.10.008
PMID: 29054348
PMCID: PMC5989634
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Grant note: UL1 TR000442 / NCATS NIH HHS P30 DK054759 / NIDDK NIH HHS
Language: English
Date published: 03/2018
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9984094358802771

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