The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment

Research output: Contribution to journalArticle

Houston Methodist Lung Outcomes Group, Edward Y Chan, Duc T Nguyen, Thomas S Kaleekal, Ahmad Goodarzi, Edward A Graviss, A Osama Gaber

BACKGROUND: Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. We sought to create a unique risk stratification model using only preoperative recipient data to predict one-year postoperative mortality during our pre-transplant assessment.

METHODS: Data of lung transplant recipients at Houston Methodist Hospital (HMH) from 1/2009 to 12/2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality post-transplant were assigned weights based on the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium- and high-risk categories. Our model was validated using the validation dataset and data from other US transplant centers in the UNOS database RESULTS: We randomized 633 lung recipients from HMH into the development (n=317 patients) and validation cohort (n=316). One-year survival after transplant was significantly different among risk groups: 95% (low-risk), 84% (medium-risk), and 72% (high-risk) (p<0.001) with a C-statistic of 0.74. Patient survival in the validation cohort was also significantly different among risk groups (85%, 77% and 65%, respectively, p<0.001). Validation of the model with the UNOS dataset included 9,920 patients and found 1-year survival to be 91%, 86% and 82%, respectively (p < 0.001).

CONCLUSIONS: Using only recipient data collected at the time of pre-listing evaluation, our simple scoring system has good discrimination power and can be a practical tool in the assessment and selection of potential lung transplant recipients.

Original languageEnglish (US)
JournalThe Annals of thoracic surgery
DOIs
StateE-pub ahead of print - May 10 2019

PMID: 31082356

Altmetrics

Cite this

Standard

The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment. / Houston Methodist Lung Outcomes Group.

In: The Annals of thoracic surgery, 10.05.2019.

Research output: Contribution to journalArticle

Harvard

Houston Methodist Lung Outcomes Group 2019, 'The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment' The Annals of thoracic surgery. https://doi.org/10.1016/j.athoracsur.2019.03.108

APA

Houston Methodist Lung Outcomes Group (2019). The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment. The Annals of thoracic surgery. https://doi.org/10.1016/j.athoracsur.2019.03.108

Vancouver

Houston Methodist Lung Outcomes Group. The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment. The Annals of thoracic surgery. 2019 May 10. https://doi.org/10.1016/j.athoracsur.2019.03.108

Author

Houston Methodist Lung Outcomes Group. / The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment. In: The Annals of thoracic surgery. 2019.

BibTeX

@article{08183b80584343d98a16275809e8d797,
title = "The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment",
abstract = "BACKGROUND: Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. We sought to create a unique risk stratification model using only preoperative recipient data to predict one-year postoperative mortality during our pre-transplant assessment.METHODS: Data of lung transplant recipients at Houston Methodist Hospital (HMH) from 1/2009 to 12/2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality post-transplant were assigned weights based on the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium- and high-risk categories. Our model was validated using the validation dataset and data from other US transplant centers in the UNOS database RESULTS: We randomized 633 lung recipients from HMH into the development (n=317 patients) and validation cohort (n=316). One-year survival after transplant was significantly different among risk groups: 95{\%} (low-risk), 84{\%} (medium-risk), and 72{\%} (high-risk) (p<0.001) with a C-statistic of 0.74. Patient survival in the validation cohort was also significantly different among risk groups (85{\%}, 77{\%} and 65{\%}, respectively, p<0.001). Validation of the model with the UNOS dataset included 9,920 patients and found 1-year survival to be 91{\%}, 86{\%} and 82{\%}, respectively (p < 0.001).CONCLUSIONS: Using only recipient data collected at the time of pre-listing evaluation, our simple scoring system has good discrimination power and can be a practical tool in the assessment and selection of potential lung transplant recipients.",
author = "{Houston Methodist Lung Outcomes Group} and Chan, {Edward Y} and Nguyen, {Duc T} and Kaleekal, {Thomas S} and Ahmad Goodarzi and Graviss, {Edward A} and Gaber, {A Osama}",
note = "Copyright {\circledC} 2019. Published by Elsevier Inc.",
year = "2019",
month = "5",
day = "10",
doi = "10.1016/j.athoracsur.2019.03.108",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier",

}

RIS

TY - JOUR

T1 - The Houston Methodist lung transplant risk model - a validated tool for pre-transplant risk assessment

AU - Houston Methodist Lung Outcomes Group

AU - Chan, Edward Y

AU - Nguyen, Duc T

AU - Kaleekal, Thomas S

AU - Goodarzi, Ahmad

AU - Graviss, Edward A

AU - Gaber, A Osama

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/5/10

Y1 - 2019/5/10

N2 - BACKGROUND: Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. We sought to create a unique risk stratification model using only preoperative recipient data to predict one-year postoperative mortality during our pre-transplant assessment.METHODS: Data of lung transplant recipients at Houston Methodist Hospital (HMH) from 1/2009 to 12/2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality post-transplant were assigned weights based on the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium- and high-risk categories. Our model was validated using the validation dataset and data from other US transplant centers in the UNOS database RESULTS: We randomized 633 lung recipients from HMH into the development (n=317 patients) and validation cohort (n=316). One-year survival after transplant was significantly different among risk groups: 95% (low-risk), 84% (medium-risk), and 72% (high-risk) (p<0.001) with a C-statistic of 0.74. Patient survival in the validation cohort was also significantly different among risk groups (85%, 77% and 65%, respectively, p<0.001). Validation of the model with the UNOS dataset included 9,920 patients and found 1-year survival to be 91%, 86% and 82%, respectively (p < 0.001).CONCLUSIONS: Using only recipient data collected at the time of pre-listing evaluation, our simple scoring system has good discrimination power and can be a practical tool in the assessment and selection of potential lung transplant recipients.

AB - BACKGROUND: Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. We sought to create a unique risk stratification model using only preoperative recipient data to predict one-year postoperative mortality during our pre-transplant assessment.METHODS: Data of lung transplant recipients at Houston Methodist Hospital (HMH) from 1/2009 to 12/2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality post-transplant were assigned weights based on the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium- and high-risk categories. Our model was validated using the validation dataset and data from other US transplant centers in the UNOS database RESULTS: We randomized 633 lung recipients from HMH into the development (n=317 patients) and validation cohort (n=316). One-year survival after transplant was significantly different among risk groups: 95% (low-risk), 84% (medium-risk), and 72% (high-risk) (p<0.001) with a C-statistic of 0.74. Patient survival in the validation cohort was also significantly different among risk groups (85%, 77% and 65%, respectively, p<0.001). Validation of the model with the UNOS dataset included 9,920 patients and found 1-year survival to be 91%, 86% and 82%, respectively (p < 0.001).CONCLUSIONS: Using only recipient data collected at the time of pre-listing evaluation, our simple scoring system has good discrimination power and can be a practical tool in the assessment and selection of potential lung transplant recipients.

U2 - 10.1016/j.athoracsur.2019.03.108

DO - 10.1016/j.athoracsur.2019.03.108

M3 - Article

JO - Annals of Thoracic Surgery

T2 - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -

ID: 48347504