Survival Benefit of Lung Transplant for Cystic Fibrosis since Lung Allocation Score Implementation
Survival Benefit of Lung Transplant for Cystic Fibrosis since Lung Allocation Score Implementation
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DOI：
10.1164/rccm.201303-0429oc
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发表时间：
2013-06-15
影响因子：
24.7
通讯作者：
Rizopoulos, Dimitris
中科院分区：
文献类型：
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作者：
Thabut, Gabriel;Christie, Jason D.;Rizopoulos, Dimitris
理由：肺移植（LT）对囊性纤维化（CF）成人患者的生存益处存在争议。目的：我们试图评估成年CF患者进行肝移植的生存获益。方法：我们使用来自美国器官共享登记联合网络的数据来识别2005年至2009年美国等待肝移植名单上的成年CF患者。等待名单上和移植后的生存时间通过Cox模型建模，该模型将移植状态作为时间相关协变量。在等待名单上，肺分配评分（LAS）的演变被用作疾病严重程度的替代指标。我们拟合了生存率和纵向疾病过程（LAS随时间）的联合分布模型。测量和主要结果：在研究期间，共有704名CF成年患者登记在等待名单上。3个月时LT的累积发生率为39.3%(95%可信区间，35.6-42.9%)，12个月时为64.7%(61.0-68.4%)，而同期在等待名单上的死亡发生率分别为8.5%（6.4-10.6%）和12.9%（10.3-15.5%）。术后3个月生存率为96.5% (94.7% -98.2%)；88.4%（85.1-91.8%）在12个月；3年为67.8%（59.9 ~ 76.8%）。肝移植可使瞬时死亡风险降低69%（51-80%）。LAS与LT的相互作用显著：LAS越高，LT的生存获益越大（P < 0.001）。结论：肝移植可提高成年CF患者的生存率。
Rationale: The survival benefit of lung transplantation (LT) in adult patients with cystic fibrosis (CF) is debated.Objectives: We sought to assess the survival benefit of LT in adult patients with CF.Methods: We used data from the United Network for Organ Sharing Registry to identify adult patients with CF 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: A total of 704 adult patients with CF were registered on a wait list during the study period. The cumulative incidence of LT was 39.3% (95% confidence interval, 35.6-42.9%) 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.