BODE Score May Need Reevaluation for Lung Transplant Screening, Study Suggests

Patrícia Silva, PhD avatar

by Patrícia Silva, PhD |

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Survival in patients with chronic obstructive pulmonary disease (COPD) in need of lung transplantation might be considerably better than previously predicted, a new study recently published in the journal CHEST suggested.

Because COPD is one of the leading indications for lung transplant — a third of all lung transplants are due to COPD — all candidates must undergo strict evaluation before receiving a transplant. Physicians must identify patients who have an excessive burden from comorbid conditions, which could compromise the success of a transplant.

One of the measurements used to assess a candidate’s condition is the body mass index, obstruction, dyspnea (shortness of breath), and exercise capacity score, known as the BODE score. This method is used to determine prognosis factors for potential lung transplant recipients. Yet, although this scoring system is used globally, it had not been validated in the context of lung transplants.

In the study, “Survival of Lung Transplant Candidates With COPD: BODE Score Reconsidered,” researchers sought to test the hypothesis that COPD patients selected as transplant candidates have better survival than the BODE score might indicate.

Researchers conducted a retrospective analysis of survival according to the BODE score and compared the results between COPD patients in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (4,377 patients) and COPD patients in the cohort in which the BODE score was validated (625 patients).

The team found that the risk of death was higher in the BODE validation cohort — median survival was 37 months in the BODE validation group and 59 months in the UNOS group.

According to the team, these findings show that the survival rate of patients selected as candidates for lung transplant is significantly higher than predicted by BODE scores.

“Survival of patients with COPD who are considered candidates for lung transplantation is significantly better than would be predicted by extrapolation of survival from the cohort in which the BODE score was validated,” Robert Reed, lead author of the study, said in a press release. “This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplant evaluation screening process.”

The team concluded that “although BODE mortality predictions are used to inform prognosis surrounding transplantation decision-making, our study would support reconsideration of this practice,” the researchers wrote.