title: True survival benefit of lung transplantation for cystic fibrosis patients: the Zurich experience.
abstract: BACKGROUND
  Lung transplantation is the ultimate therapy for end-stage cystic fibrosis (CF) lung disease; however, the debate continues as to whether lung transplantation improves survival. We report post-transplant outcome in CF at our institution by comparing 5-year post-transplant survival with a calculated 5-year survival without lung transplantation, using a predictive 5-year survivorship model, and describe pre-transplant parameters influencing transplant outcome.
  
  
  METHODS
  CF patients undergoing lung transplantation at our center were included (1992 to 2007). Survival rates were calculated and compared, and univariate and multivariate Cox regression analyses were used for statistical assessment.
  
  
  RESULTS
  Eighty transplants were performed in CF patients, 11 (13.8%) of whom were children. Mean age at transplant was 26.2 years (95% confidence interval: 24.4 to 28.0). The Liou raw score at transplant was -20 (95% confidence interval: -16 to -24), resulting in an estimated 5-year survival without transplantation of 33 +/- 14%, compared with a 5-year post-transplant survival of 68.2 +/- 5.6%. Further improvement was noted in the recent transplant era (since 2000), with a 5-year survival of 72.7 +/- 7.3%. Univariate analysis revealed that later year of transplant and diagnosis of diabetes influenced survival positively. Pediatric age had no negative impact. In the multivariate analysis, only diabetes influenced survival, in a positive manner.
  
  
  CONCLUSIONS
  Lung transplantation performed at centers having experience with the procedure can offer a true survival benefit to patients with end-stage CF lung disease.
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Hofer
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Sarosh
authors.initials: S
authors.lastname: Irani
authors.forename: Rudolf
authors.initials: R
authors.lastname: Speich
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler