Published ahead of print on December 30, 2005, doi:10.1164/rccm.200410-1369OC
American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 659-666, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200410-1369OC
Risk Factors for Death of Patients with Cystic Fibrosis Awaiting Lung Transplantation
Richard A. Belkin,
Noreen R. Henig,
Lianne G. Singer,
Cecilia Chaparro,
Ronald C. Rubenstein,
Sharon X. Xie,
Justin Y. Yee,
Robert M. Kotloff,
David A. Lipson and
Greta R. Bunin
Divisions of Pulmonary, Allergy, and Critical Care, and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center; Divisions of Pulmonary Medicine and Oncology, Children's Hospital of Philadelphia; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California; and Division of Respirology, University Health Network and University of Toronto, Toronto, Ontario, Canada
Correspondence and requests for reprints should be addressed to Richard A. Belkin, M.D., Department of Pulmonary and Critical Care Medicine, Sansum-Santa Barbara Medical Foundation Clinic, 215 Pesetas Lane, Santa Barbara, CA 93110. E-mail: rbelkin{at}sansumclinic.org
Rationale: The optimal timing for listing of cystic fibrosis patients for lung transplantation is controversial.
Objectives: We conducted a retrospective cohort study of 343 patients listed for lung transplantation at four academic medical centers to identify risk factors for death while awaiting transplantation.
Methods: Data on possible risk factors were abstracted from medical records.
Measurements: Time to death, patient demographic characteristics, and risk factors for death while awaiting transplantation were assessed. Univariate and multivariate survival analyses were performed using Cox regression.
Results: By univariate analyses, FEV1 30% predicted (HR, 3.8; 95% CI, 2.07.5), PaCO2 50 mm Hg (HR, 1.85; 95% CI, 1.13.0), and shorter height (HR, 1.8; 95% CI, 1.13.0) were associated with a higher risk of death. Referral from an accredited cystic fibrosis center was associated with a lower risk (HR, 0.53; 95% CI, 0.300.92). The final multivariate model included referral from an accredited cystic fibrosis center (HR, 0.5; 95% CI, 0.31.0) and listing year after 1996 (HR, 0.4; 95% CI, 0.20.7); both were associated with a lower risk of death. FEV1 30% predicted (HR, 6.8; 95% CI, 2.419.3), PaCO2 50 mm Hg (HR, 6.9; 95% CI, 1.532.1), and use of a nutritional intervention (HR, 2.3; 95% CI, 1.34.1) were associated with increased risk. Patients with FEV1 > 30% predicted had a higher risk of death only when their PaCO2 was 50 mm Hg (HR, 7.0; 95% CI, 1.532), while the increased risk of death with FEV1 30% was not further influenced by the presence of hypercapnia.
Conclusions: We identified risk factors for waiting list mortality that could impact on transplant listing and allocation guidelines.
Key Words: cystic fibrosis lung transplantation survival
This article has been cited by other articles:

|
 |

|
 |
 
S. C. Sweet
Pediatric Lung Transplantation
Proceedings of the ATS,
January 15, 2009;
6(1):
122 - 127.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. A. Corris and J. D. Christie
Update in Transplantation 2007
Am. J. Respir. Crit. Care Med.,
May 15, 2008;
177(10):
1062 - 1067.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. B. Ware
Clinical Year in Review III: Asthma, Lung Transplantation, Cystic Fibrosis, Acute Respiratory Distress Syndrome
Proceedings of the ATS,
September 15, 2007;
4(6):
489 - 493.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Mayer-Hamblett, B. W. Ramsey, and R. A. Kronmal
Advancing Outcome Measures for the New Era of Drug Development in Cystic Fibrosis
Proceedings of the ATS,
August 1, 2007;
4(4):
370 - 377.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. J. Accurso
Update in Cystic Fibrosis 2006
Am. J. Respir. Crit. Care Med.,
April 15, 2007;
175(8):
754 - 757.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. Mayer-Hamblett, M. L. Aitken, F. J. Accurso, R. A. Kronmal, M. W. Konstan, J. L. Burns, S. D. Sagel, and B. W. Ramsey
Association between Pulmonary Function and Sputum Biomarkers in Cystic Fibrosis
Am. J. Respir. Crit. Care Med.,
April 15, 2007;
175(8):
822 - 828.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Hadjiliadis
Special Considerations for Patients With Cystic Fibrosis Undergoing Lung Transplantation
Chest,
April 1, 2007;
131(4):
1224 - 1231.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. A. Corris and J. D. Christie
Update in Transplantation 2006
Am. J. Respir. Crit. Care Med.,
March 1, 2007;
175(5):
432 - 435.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Vilozni, L. Bentur, O. Efrati, T. Minuskin, A. Barak, A. Szeinberg, H. Blau, E. Picard, E. Kerem, Y. Yahav, et al.
Spirometry in Early Childhood in Cystic Fibrosis Patients
Chest,
February 1, 2007;
131(2):
356 - 361.
[Abstract]
[Full Text]
[PDF]
|
 |
|
Copyright © 2006 American Thoracic Society
|
|
|