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Published ahead of print on February 1, 2005, doi:10.1164/rccm.200407-900OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 9, May 2005, 1053-1059

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Submitted on July 13, 2004
Accepted on January 22, 2005

Use of Lung Transplantation Survival Models to Refine Patient Selection in Cystic Fibrosis

Theodore G Liou1*, Frederick R Adler2, and David Huang3

1 Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA, 2 Department of Biology, University of Utah, Salt Lake City, UT, USA; Department of Mathematics, University of Utah, Salt Lake City, UT, USA, 3 Neuropsychiatric Institute, University of California, Los Angeles, CA, USA

* To whom correspondence should be addressed. E-mail: ted.liou{at}utah.edu.

Lung transplantation in cystic fibrosis improves survival for patients with low 5-year predicted survival. Identifying characteristics that affect post-transplantation survival may improve patient selection and survival benefit. Using Cystic Fibrosis Foundation Patient Registry and United Network for Organ Sharing data, we identify 852 transplanted patients from 1991-2001, and 12,867 control patients from 1997. We used Cox proportional hazards models to identify variables that influence post-transplantation survival. To estimate the survival benefit of transplantation for patients affected by identified variables, we comparing Kaplan-Meier survival curves of transplanted and control patients stratified by 5-year predicted survival. Post-transplantation survival improved annually. Youth, Burkholderia cepacia and cystic fibrosis-related arthropathy increased the post-transplantation hazard of death. Compared to controls, transplanted adults with a 5-year predicted survival <50% without B. cepacia or arthropathy have improved survival. Transplanted adults with B. cepacia, arthropathy or 5-year predicted survival >50% have decreased survival. Transplantation never improves survivorship for pediatric patients. Patients with arthropathy, B. cepacia infection or younger age derive no aggregate survival benefit and must appraise carefully the high risk of decreased post-transplantation survival. Adult patients with low 5-year predicted survival without B. cepacia infection should receive priority for lung transplantation.
Key words: Cox proportional hazards model, organ allocation, age, arthropathy, Burkholderia cepacia




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