p.2
Single vs Double Lung Transplant
How did the survival outcomes compare between single and double lung transplants?
Double lung transplant recipients had significantly better survival outcomes than single lung transplant recipients.
p.5
Comparison of AATD and Usual COPD Outcomes
What role does AAT play in lung function and inflammation?
AAT inhibits neutrophil serine proteases and reduces inflammation.
p.5
Comparison of AATD and Usual COPD Outcomes
What was the finding regarding FEV1 rates in AATD patients after lung transplantation?
Similar rates of decline in FEV1 for single lung transplants but faster decline for double lung transplants.
p.2
Impact of Pre- and Post-Transplant Factors on Survival
What were some pre- and post-transplant characteristics evaluated for their association with mortality?
Age, gender, BMI, pre-transplant oxygen requirement, mPAP, ECMO presence, type of lung transplant, CMV and EBV mismatch, ischemia time, re-intubation, length of hospitalization, and treatment for acute rejection.
p.1
Comparison of AATD and Usual COPD Outcomes
How does the post-lung transplant mortality of AATD patients compare to usual COPD patients?
AATD patients have increased post-LT mortality due to infections and liver disease.
p.2
Survival Rates Post-Lung Transplant
What was the median survival for single and double lung transplants?
4.4 years for single LT and 7.7 years for double LT.
p.4
Causes of Mortality in AATD Patients
How does the risk of infections in AATD patients compare to usual COPD patients?
AATD patients have a higher risk of infections (HR 1.21, CI 1.04 – 1.42, p = 0.02).
p.4
Single vs Double Lung Transplant
What is the survival advantage of double lung transplants compared to single lung transplants for AATD patients?
There is a significant survival advantage for double lung transplants.
What is the primary objective of the study on lung transplantation in AATD patients?
To describe disease-specific outcomes in patients with alpha-1 antitrypsin deficiency (AATD) following lung transplantation.
p.2
Patient Demographics and Characteristics
What percentage of AATD patients received a lung transplant in the study?
66% of the 1556 AATD patients had died by the time of data analysis.
p.5
Survival Rates Post-Lung Transplant
How does the 10-year survival rate for AATD patients compare to usual COPD patients?
23% for AATD compared to 43% for usual COPD.
p.5
Future Research Directions in AATD Treatment
What is being investigated regarding AAT infusion therapy post-lung transplant?
Its impact on pulmonary function tests and bronchiolitis obliteration syndrome.
p.5
Survival Rates Post-Lung Transplant
What was the initial survival trend observed in AATD patients post-lung transplant?
Worse initial survival followed by improved outcomes around the 4-year mark.
p.4
Causes of Mortality in AATD Patients
What were the common etiologies leading to death for AATD and COPD patients?
Both AATD and COPD share the same eight most common etiologies.
p.1
Single vs Double Lung Transplant
How does survival compare between double lung transplant and single lung transplant in AATD patients?
Double lung transplant has a median survival of 7.7 years compared to 4.4 years for single lung transplant.
p.2
Survival Rates Post-Lung Transplant
What were the survival rates for AATD patients at 1, 5, and 10 years post-transplant?
82%, 56%, and 34%, respectively.
p.3
Impact of Pre- and Post-Transplant Factors on Survival
What does the biphasic course in survival rates indicate?
It indicates non-proportional hazards that may be unadjusted for potential unobserved or unavailable factors.
p.4
Survival Rates Post-Lung Transplant
What is the median survival time for AATD lung transplant recipients?
6.4 years (IQR 1.8 – 12.2 years).
p.3
Impact of Pre- and Post-Transplant Factors on Survival
What does the Cox proportional hazard ratio indicate about age in AATD patients?
Age has a hazard ratio of 5.68, indicating a significant impact on survival.
p.1
Survival Rates Post-Lung Transplant
What were the 1-, 5-, and 10-year survival rates for AATD patients post-lung transplant?
82%, 56%, and 34%, respectively.
p.2
Patient Demographics and Characteristics
What was the median waiting-list time for lung transplantation?
263 days, reduced to 158 days after the lung allocation score was instituted.
p.2
Causes of Mortality in AATD Patients
What were the most common causes of mortality among AATD recipients?
Infection (23%), graft failure (23%), and respiratory failure (16%).
p.3
Impact of Pre- and Post-Transplant Factors on Survival
What factor had a significant hazard ratio affecting survival in AATD patients?
CMV mismatch (present) with a hazard ratio of 1.57.
p.2
Survival Rates Post-Lung Transplant
What statistical model was used to evaluate mortality after lung transplantation (LT)?
Cox proportional hazard model.
p.1
Impact of Pre- and Post-Transplant Factors on Survival
What factors were found to impact post-lung transplant mortality in AATD patients?
Increasing age, presence of CMV mismatch, reintubation prior to discharge, and requiring treatment for rejection within one year.
p.3
Single vs Double Lung Transplant
How does the median survival of AATD single lung transplant recipients compare to double lung transplant recipients?
AATD single LT had a median survival of 4.4 years, which is lower than the 7.7 years for double LT.
p.3
Survival Rates Post-Lung Transplant
What was observed about the survival rates of AATD lung transplant recipients compared to usual COPD recipients?
AATD LT recipients had a higher failure rate initially, which improved over time and surpassed usual COPD.
p.2
Impact of Pre- and Post-Transplant Factors on Survival
What factors impacted post-lung transplant mortality?
Increasing age, presence of CMV mismatch, reintubation prior to discharge, and requiring treatment for rejection within one year.
p.5
Impact of Pre- and Post-Transplant Factors on Survival
What factors were associated with increased post-lung transplant mortality in AATD patients?
Increasing age, CMV mismatch, and requiring treatment for rejection within the first year.
p.5
Impact of Pre- and Post-Transplant Factors on Survival
What is the significance of neutrophil elastase activity in AATD patients post-lung transplant?
Unopposed neutrophil elastase activity may contribute to lung injury and susceptibility to infections.
p.4
Causes of Mortality in AATD Patients
What notable difference in mortality was observed for liver failure between AATD and usual COPD patients?
Liver failure accounted for 2% in AATD compared to 0.4% in usual COPD (HR 5.67, p < 0.001).
