The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates.

Castleberry, Anthony; Mulvihill, Michael S; Yerokun, Babatunde A; Gulack, Brian C; Englum, Brian; Snyder, Laurie; Worni, Mathias; Osho, Asishana; Palmer, Scott; Davis, R Duane; Hartwig, Matthew G (2017). The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates. Journal of heart and lung transplantation, 36(7), pp. 780-786. Elsevier 10.1016/j.healun.2016.12.015

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BACKGROUND The lung allocation score (LAS) has led to improved organ allocation for transplant candidates. At present, the 6-minute walk distance (6MWD) is treated as a binary categorical variable of whether or not a candidate can walk more than 150 feet in 6 minutes. In this study, we tested the hypothesis that 6MWD is presently under-utilized with respect to discriminatory power, and that, as a continuous variable, could better prognosticate risk of waitlist mortality. METHODS A retrospective cohort analysis was performed using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) transplant database. Candidates listed for isolated lung transplant between May 2005 and December 2011 were included. The population was stratified by 6MWD quartiles and unadjusted survival rates were estimated. Multivariable Cox proportional hazards modeling was used to assess the effect of 6MWD on risk of death. The Scientific Registry of Transplant Recipients (SRTR) Waitlist Risk Model was used to adjust for confounders. The optimal 6MWD for discriminative accuracy in predicting waitlist mortality was assessed by receiver-operating characteristic (ROC) curves. RESULTS Analysis was performed on 12,298 recipients. Recipients were segregated into quartiles by distance walked. Waitlist mortality decreased as 6MWD increased. In the multivariable model, significant variables included 6MWD, male gender, non-white ethnicity and restrictive lung diseases. ROC curves discriminated 6-month mortality was best at 655 feet. CONCLUSIONS The 6MWD is a significant predictor of waitlist mortality. A cut-off of 150 feet sub-optimally identifies candidates with increased risk of mortality. A cut-off between 550 and 655 feet is more optimal if 6MWD is to be treated as a dichotomous variable. Utilization of the LAS as a continuous variable could further enhance predictive capabilities.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Worni, Mathias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1053-2498

Publisher:

Elsevier

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

05 Mar 2018 12:41

Last Modified:

01 Aug 2018 02:30

Publisher DOI:

10.1016/j.healun.2016.12.015

PubMed ID:

28131666

Uncontrolled Keywords:

6-minute walk distance candidate assessment lung transplantation organ allocation waitlist mortality

BORIS DOI:

10.7892/boris.109062

URI:

https://boris.unibe.ch/id/eprint/109062

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