Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation
Debbie Rybak
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorMichael B. Fallon
Department of Medicine, University of Alabama, Birmingham, AL
Search for more papers by this authorMichael J. Krowka
Department of Medicine, Mayo Clinic, Rochester, MN
Search for more papers by this authorRobert S. Brown Jr
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorJenna Reinen
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorLinda Stadheim
Department of Medicine, Mayo Clinic, Rochester, MN
Search for more papers by this authorDorothy Faulk
Department of Medicine, University of Alabama, Birmingham, AL
Search for more papers by this authorCarrie Nielsen
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Search for more papers by this authorNadine Al-Naamani
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorKari Roberts
Department of Medicine, Tufts–New England Medical Center, Boston, MA
Search for more papers by this authorSteven Zacks
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Search for more papers by this authorTed Perry
Department of Medicine, University of Colorado, Denver, CO
Search for more papers by this authorJames Trotter
Department of Medicine, University of Colorado, Denver, CO
Search for more papers by this authorCorresponding Author
Steven M. Kawut
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
Telephone: 212-305-7771; FAX: 212-342-5382
Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH 8E, Room 101, New York, NY 10032Search for more papers by this authorPulmonary Vascular Complications of Liver Disease Study Group
The Pulmonary Vascular Complications of Liver Disease Study Group also includes the following: Jeffrey Okun, B.A., Daniel Rabinowitz, Ph.D., Evelyn M. Horn, M.D., Lori Rosenthal, N.P., and Sonja Olsen, M.D., from Columbia University; Vijay Shah, M.D., and Russell Wiesner, M.D., from the Mayo Clinic; J. Stevenson Bynon, M.D., Devin Eckhoff, M.D., Harpreet Singh, Rajasekhar Tanikella, Raymond L. Benza, M.D., and Keith Wille, M.D., from the University of Alabama; Lisa Forman, M.D., and David Badesch, M.D., from the University of Colorado; Roshan Shrestha, M.D., from The University of North Carolina at Chapel Hill; Darren B. Taichman, M.D., Ph.D., Vivek Ahya, M.D., Harold Palevsky, M.D., and Rajender Reddy, M.D., from the University of Pennsylvania; and Neil Kaplowitz, M.D., and James Knowles, M.D., Ph.D., from the University of Southern California.
Search for more papers by this authorDebbie Rybak
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorMichael B. Fallon
Department of Medicine, University of Alabama, Birmingham, AL
Search for more papers by this authorMichael J. Krowka
Department of Medicine, Mayo Clinic, Rochester, MN
Search for more papers by this authorRobert S. Brown Jr
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorJenna Reinen
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorLinda Stadheim
Department of Medicine, Mayo Clinic, Rochester, MN
Search for more papers by this authorDorothy Faulk
Department of Medicine, University of Alabama, Birmingham, AL
Search for more papers by this authorCarrie Nielsen
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Search for more papers by this authorNadine Al-Naamani
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Search for more papers by this authorKari Roberts
Department of Medicine, Tufts–New England Medical Center, Boston, MA
Search for more papers by this authorSteven Zacks
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
Search for more papers by this authorTed Perry
Department of Medicine, University of Colorado, Denver, CO
Search for more papers by this authorJames Trotter
Department of Medicine, University of Colorado, Denver, CO
Search for more papers by this authorCorresponding Author
Steven M. Kawut
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
Telephone: 212-305-7771; FAX: 212-342-5382
Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH 8E, Room 101, New York, NY 10032Search for more papers by this authorPulmonary Vascular Complications of Liver Disease Study Group
The Pulmonary Vascular Complications of Liver Disease Study Group also includes the following: Jeffrey Okun, B.A., Daniel Rabinowitz, Ph.D., Evelyn M. Horn, M.D., Lori Rosenthal, N.P., and Sonja Olsen, M.D., from Columbia University; Vijay Shah, M.D., and Russell Wiesner, M.D., from the Mayo Clinic; J. Stevenson Bynon, M.D., Devin Eckhoff, M.D., Harpreet Singh, Rajasekhar Tanikella, Raymond L. Benza, M.D., and Keith Wille, M.D., from the University of Alabama; Lisa Forman, M.D., and David Badesch, M.D., from the University of Colorado; Roshan Shrestha, M.D., from The University of North Carolina at Chapel Hill; Darren B. Taichman, M.D., Ph.D., Vivek Ahya, M.D., Harold Palevsky, M.D., and Rajender Reddy, M.D., from the University of Pennsylvania; and Neil Kaplowitz, M.D., and James Knowles, M.D., Ph.D., from the University of Southern California.
Search for more papers by this authorAbstract
Chronic obstructive pulmonary disease (COPD) may cause significant symptoms and have an impact on survival. Smoking is an important risk factor for COPD and is common in candidates for liver transplantation; however, the risk factors for and outcomes of COPD in this population are unknown. We performed a prospective cohort study of 373 patients being evaluated for liver transplantation at 7 academic centers in the United States. COPD was characterized by expiratory airflow obstruction and defined as follows: prebronchodilator forced expiratory volume in 1 second/forced vital capacity < 0.70. Patients completed the Liver Disease Quality of Life Questionnaire 1.0, which included the Short Form-36. The mean age of the study sample was 53 ± 9 years, and 234 (63%) were male. Sixty-seven patients (18%, 95% confidence interval 14%-22%) had COPD, and 224 (60%) had a history of smoking. Eighty percent of patients with airflow obstruction did not previously carry a diagnosis of COPD, and 27% were still actively smoking. Older age and any smoking (odds ratio = 3.74, 95% confidence interval 1.94-7.23, P < 0.001) were independent risk factors for COPD. Patients with COPD had worse New York Heart Association functional class and lower physical component summary scores on the 36-Item Short Form but had short-term survival similar to that of patients without COPD. In conclusion, COPD is common and often undiagnosed in candidates for liver transplantation. Older age and smoking are significant risk factors of COPD, which has adverse consequences on functional status and quality of life in these patients. Liver Transpl 14:1357–1365, 2008. © 2008 AASLD.
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