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March 27, 2002

Priorities for Lung Transplantation Among Patients With Cystic Fibrosis—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(12):1523-1525. doi:10.1001/jama.287.12.1523

In Reply: We appreciate Mr Maish's comments about our work and the important issue of quality of life (QOL). We found that only the sickest patients with CF had a survival benefit from lung transplantation. To answer Maish's specific question, we previously examined the apparent superior survival of transplanted patients from group 1 compared with groups 2 and 3 (Figure 1 in our article) and found no statistical difference.

The greater issue is his concern that physicians might lose sight of the toll that CF has on QOL. The principle primum non nocere (first, do no harm) requires physicians to consider risks before recommending any procedure. Our study provides the first estimate of survival risks and benefits of lung transplantation for patients with CF stratified by predicted survival. We focused on survival because it is an indisputable end point for measuring the benefit of therapy.

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