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Liou TG, Adler FR, Cahill BC, et al. Survival Effect of Lung Transplantation Among Patients With Cystic Fibrosis. JAMA. 2001;286(21):2683–2689. doi:10.1001/jama.286.21.2683
Author Affiliations: Division of Respiratory, Critical Care and Occupational Pulmonary Medicine (Drs Liou, Cahill, and Marshall), Departments of Mathematics and Biology (Dr Adler), Lung Transplantation Program (Dr Cahill), and Intermountain Cystic Fibrosis Center (Drs Liou and Marshall), University of Utah, Salt Lake City; Medical Department, Cystic Fibrosis Foundation, Bethesda, Md (Dr FitzSimmons); Salt Lake Veterans Affairs Medical Center, Salt Lake City, Utah (Dr Marshall); School of Public Health, University of California, Los Angeles (Dr Huang); and the New York State Department of Health, Albany (Dr Hibbs). Dr FitzSimmons is now with FitzSimmons and Associates.
Context Patients with cystic fibrosis (CF) are the second largest group of lung
transplant recipients in the United States. The survival effect of transplantation
on a general CF population has not previously been measured.
Objective To determine the impact of bilateral lung transplantation on survival
in patients with CF.
Design, Setting, and Patients Retrospective observational cohort study of 11 630 CF patients
who did not undergo lung transplantation (controls) and 468 transplant recipients
with CF from 115 CF centers in the United States, 1992-1998. Patients were
stratified into 5 groups based on a 5-year survival prediction model (survival
group 1: <30%; survival group 2: 30 to <50%; survival groups 3-5: 50
Main Outcome Measure Five-year survival from date of transplantation in 1992-1997 in the
transplant group and from January 1, 1993, in the control group.
Results Lung transplantation increased 5-year survival of CF patients in survival
group 1. Survival group 2 had equivocal survival effects, and groups 3-5 had
negative survival effects from transplantation. From 1994-1997, there was
a mean annual prevalence of 238 patients in survival group 1 and mean annual
incidence of 154 patients entering the group, approximately 1.5 times the
number of lung transplantations performed each year in CF patients (mean,
104). Use of the criterion of forced expiratory volume in 1 second of less
than 30% resulted in an equivocal survival benefit and identified 1458 potential
candidates for transplantation in 1993.
Conclusions Cystic fibrosis patients in group 1 have improved 5-year survival after
lung transplantation. The majority of patients with CF have equivocal or negative
survival effects from the procedure. Selection of patients with CF for transplantation
based on group 1 survival predictions maximizes survival benefits to individuals
and may reduce the demand for scarce donor organs.
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