Study: Short people may be at disadvantage for lung transplants
Tuesday, January 12, 2016
Short people have lower odds of getting a lung transplant, according to a recent report by Columbia University Medical Center (CUMC).
Researchers found that lung transplant candidates with short stature are more likely to experience long waiting times and higher rates of death and respiratory failure while on the waiting list compared to candidates of average height. Since women are generally shorter than are men, this disparity puts females at particular risk.
"Surgeons commonly try to match small transplant candidates with small donor lungs, because they believe it leads to better outcomes," said David J. Lederer, M.D., M.S., study leader and an associate professor of medicine and epidemiology at CUMC.
"But the latest evidence indicates that this approach causes short people to get fewer transplants and have worse outcomes. Small recipients can cope with larger lungs, and surgeons can reduce the size of lungs before transplant, with good results. So, there's no scientific or medical reason for this bias against shorter people."
The research team analyzed data gathered from 13,346 adults on the lung transplant waiting list in the United States between the years 2005 and 2011. They found that individuals who were 5-foot-4 or shorter had a 34 percent lower rate of transplantation compared to patients who were 5-7 to 5-9 tall.
Shorter patients had a 62 percent higher rate of mortality or removal from the waiting list because of clinical deterioration. These shorter individuals had a 42 percent higher rate of respiratory failure while awaiting a lung transplant as compared with their taller counterparts.
In the conclusion of the study, published in the online edition of the American Journal of Respiratory and Critical Care Medicine, the authors suggest several ways transplant centers might reduce the disparity:
- Doctors can surgically downsize donor lungs to allow shorter patients to receive slightly oversized lungs, a procedure that has resulted in better outcomes than using size-matched donor organs
- Surgeons can perform lobar transplants, a practice in which two living donors each give one lung lobe to a single recipient.
- Administrators could address the disparity by changing any allocation policies that consider patient height as a determining factor.
The data from the study suggests revising the prioritization of transplant patients may ensure that patients of shorter stature enjoy equal priority to their taller counterparts, and it may also help correct gender disparities existing in waiting list outcomes.
Revised prioritization can have a profound effect on the thousands of patients awaiting lung transplants. In 2014 alone, 1,880 adults and 45 children underwent the procedure in the United States, and 2,584 joined the waiting list.
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