Changing demographics and outcomes of lung transplantation recipients with cystic fibrosis

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• 作者：Naritaka Kimura ; MD^a ; ^{naritaku@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Muhammad S. Khan ; MD^b ; Marc Schecter ; MD^c ; Raheel Rizwan ; MD^a ; Roosevelt Bryant III ; MD^a ; Erin Wells ; RN^c ; Christopher Towe ; MD^c ; Farhan Zafar ; MD^a ; David L.S. Morales ; MD^a
• 关键词：lung transplantation ; cystic fibrosis ; demographics ; lung allocation score system ; transplant candidacy ; mechanical ventilation
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：35
• 期：10
• 页码：1237-1244
• 全文大小：1337 K

文摘

Cystic fibrosis (CF) is one of the most common diagnoses in adult and pediatric patients undergoing lung transplantation (LTx). A changing pattern of indications for LTx among patients with CF has been noted. This study analyzes the prevalence and characteristics of patients with CF who underwent LTx in the current era.

Methods

A retrospective analysis was performed using data from the United Network of Organ Sharing database of all LTx performed from 1999 to 2013 (N = 20,345). Sub-analyses focused on children (<18 years old). Patients with CF who underwent LTx were assigned to early (1999–2003), mid (2004–2008), and current (2009–2013) eras based on the date of the procedure as well as before and after implementation of the new lung allocation score system in 2005.

Results

CF was the indication for LTx in 14% (2,877) of who patients underwent LTx, a decrease from >17% in the early era to <13% in the current era (p < 0.001). In the pediatric cohort, CF was the indication for LTx in 383 (53%) patients, a proportion that also decreased across eras (early, 60%; mid, 53%; current, 47%; p = 0.009). The mean age of patients with CF undergoing LTx increased across the eras (early, 28 years ± 10; mid. 28 years ± 10; current, 30 years ± 11; p < 0.001). Pre-transplant ventilator use and incidence of pan-resistant infections also increased (p < 0.001), whereas pre-transplant forced expiratory volume in 1 second and waitlist times decreased (p < 0.001) in patients with CF. Graft survival across the eras remained similar (p > 0.05) at 5.1 years overall.

Conclusions

The proportion of LTx performed for CF has significantly decreased over time, a trend especially pronounced in pediatric patients. The change in pre-transplant characteristics across eras indicates a trend to perform LTx in more clinically ill and older patients with CF. The overall post-LTx survival has not changed.