title: Survival benefit of lung transplant for cystic fibrosis since lung allocation score implementation.
abstract: BACKGROUND
  The survival benefit of lung transplantation (LT) in adult patients with cystic fibrosis (CF) is debated.
  
  
  OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Service de Pneumologie B et Transplantation Pulmonaire, Université Paris 7 Denis Diderot, Hôpital Bichat, Paris, France. g.thabut@gmail.com
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
authors.forename: Michel
authors.initials: M
authors.lastname: Fournier
authors.forename: Olivier
authors.initials: O
authors.lastname: Brugière
authors.forename: Guy
authors.initials: G
authors.lastname: Leseche
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Dimitris
authors.initials: D
authors.lastname: Rizopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D003550:Cystic Fibrosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D012720:Severity of Illness Index; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult