Am J Respir Crit Care Med. 2013 Apr 13. [Epub ahead of print]
Survival Benefit of Lung Transplant for Cystic Fibrosis since Lung-Allocation-Score Implementation.
Source
Hôpital Bichat, Service de pneumologie B et transplantation Pulmonaire, 46 rue Henri Huchard, Paris, France, 75018, (1) 40 25 69 09, (1) 40256104 ; gthabut@gmail.com.
Abstract
Rationale. The survival benefit of lung transplantation (LT) in adult patients with cystic fibrosis (CF) is debated. Objective: We sought to assess the survival benefit of lung transplantation in adult CF patients. Methods. We used data from the UNOS Registry to identify adult CF patients on a wait list for LT in the United States between 2005 and 2009. Survival times while on the wait list and after LT were modeled by use of a Cox model that incorporated transplantation status as a time-dependent covariate. Evolution in Lung Allocation Score (LAS) while on the wait list was used as a surrogate for disease severity. We fitted a model for the joint distribution of survival and longitudinal disease process (LAS over time). Measurements and main results: 704 adult patients with CF were registered on a wait list during the study period. The cumulative incidence of LT was 39.3% (95%CI:42.9-35.6%) at 3 months and 64.7% (61.0-68.4%) at 12 months, whereas the incidence of death while on the wait list at the same times was 8.5% (6.4-10.6%) and 12.9% (10.3-15.5%), respectively. Survival after LT was 96.5% (94.7-98.2%) at 3 months, 88.4% (85.1-91.8%) at 12 months and 67.8% (59.9-76.8%) at 3 years. LT conferred a 69% reduction in the instantaneous risk of death (51% - 80%). The interaction between LAS and LT was significant: the higher the LAS, the greater the survival benefit of LT (p<0.001). Conclusions: LT confers a survival benefit for adult patients with CF.
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