Background. Lung transplantation (LTx) benefit for survival in cystic fibrosis (CF) patients placed on the wait list is not well studied. Methods. To predict the relationship between initial forced expiratory volume in 1 second (FEV<inf>1</inf>) and forced vital capacity (FVC) and the hazard ratio (HR) associated with LTx in CF patients, the United Network for Organ Sharing database was queried from 2005 to 2006 for adult patients with CF. Survival was assessed from wait list entry time until death on wait list, death after LTx, or censoring. Multivariate Cox proportional hazards models were used to assess the effect of LTx. The first model estimated the HR of LTx with adjustment for FEV<inf>1</inf> or FVC and other covariates, and the second model estimated the HR of LTx conditional on FEV<inf>1</inf> or FVC at listing. Results. Two hundred seventy-eight patients with CF were included in the cohort, and 277 were used for survival analysis. Lung transplantation reduced the risk for death controlling for FEV<inf>1</inf> (HR, 0.601; 95% confidence interval, 0.375 to 0.964; p = 0.035) or controlling for FVC (HR, 0.547; 95% confidence interval, 0.336 to 0.889; p = 0.015). Interaction models found that the HR of LTx varied significantly across initial FEV<inf>1</inf> and FVC, with the predicted LTx HR and 95% confidence interval being protective (HR < 1) at FEV<inf>1</inf> of 25% or less and FVC of 40% or less, respectively. Conclusions. The benefit of LTx in adults with CF was significant at a lower baseline FEV<inf>1</inf> than expected. A threshold for baseline FVC was established below which LTx was protective.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine