Lung Transplant for COPD: Outcomes/Technology Assessment

肺移植治疗COPD：结局/技术评估 本提案的主要目标是对肺移植（LTx）LTx进行技术评估， 新的供体肺分配系统中的COPD患者。我们将比较LTx后与LTx前的生活质量。 新系统中患者的LTx生活质量。此外，我们将比较生活质量结果 在新制度下的结果与旧制度下的结果。 为了进行这项技术评估，我们提出了两个具体目标： 具体目标1：评估LTx在新供体肺中对COPD患者的有效性 分配制度 a.对于接受LTx的患者，评价效用（生活质量）的变化，比较LTx后6个月， LTx实用程序到LTx前实用程序。 B。假设LTx有效，通过以下方式评估效用（生活质量）改善的持续时间： 将LTx后效用与LTx前效用进行比较。 C.调整后比较移植患者与未移植患者的效用 基线差异（疾病严重程度、年龄、性别、种族等）。 具体目标2：比较LTx对COPD患者生活质量的影响， 供体肺分配系统和旧的供体肺分配系统。 在控制基线差异后，比较新旧系统实用程序和实用程序更改 （疾病严重程度、年龄、LTx类型、性别、种族等）。 为了对新分配制度的潜在修订提出假设，我们提出了第三个目标： 具体目标3：确定新供体肺LTx术后结局的术前预测因素 分配系统，用于COPD患者。 执行多变量线性回归以开发使用详细基线数据作为解释的模型 变量和从LTx前到LTx后的效用变化作为结果变量。我们还将 将LTx后效用评分（非变化评分）作为结果变量。 考虑到患者、提供者和医疗保健系统的巨大风险，我们必须 评估LTx的有效性和新的器官分配方法的影响。这项研究将试图 确定LTx对新供体肺中COPD患者的生存率和生活质量的影响 分配制度

LUNG TRANSPLANT FOR COPD: OUTCOMES/TECHNOLOGY ASSESSMENT The broad goal of this proposal is to perform a technology assessment of lung transplantation (LTx) LTx for patients with COPD in the new donor lung allocation system. We will compare post-LTx quality of life to pre- LTx quality of life of patients within the new system. In addition, we will compare the quality of life outcomes in the new system to the outcomes in the old system. To perform this technology assessment, we propose two specific aims: Specific Aim 1: Assess the effectiveness of LTx, for patients with COPD, in the new donor lung allocation system. A. For patients that undergo LTx, evaluate the change in utilities (quality of life), comparing 6 months post- LTx utilities to pre-LTx utilities. B. Assuming LTx will be effective, evaluate the duration of improvement in utilities (quality of life), by comparing post-LTx utilities to pre-LTx utilities. C. Compare the utilities of transplanted patients with the utilities of patients not transplanted, after adjusting for baseline differences (severity of illness, age, gender, race, etc). Specific Aim 2: Compare the effects of LTx on the quality of life of patients with COPD in the new donor lung allocation system and the old donor lung allocation system. Compare the new and the old system utilities and utility changes, after controlling for baseline differences (severity of illness, age, type of LTx, gender, race, etc), in patients in the two systems. To generate hypotheses for potential revision of the new allocation system, we propose a third aim: Specific Aim 3: Determine preoperative predictors of post-LTx outcomes in the new donor lung allocation system, for patients with COPD. Perform multivariable linear regression to develop a model that uses detailed baseline data as explanatory variables and the change in utilities from pre-LTx to post-LTx change as the outcome variable. We will also model post-LTx utility scores (not change scores) as the outcome variable. Given the huge stakes for the patients, the providers, and the healthcare system, it is imperative that we assess the effectiveness of LTx and the impact of new organ allocation methods. This study will attempt to determine the survival and quality of life effects of LTx on patients with COPD in the new donor lung allocation system.