title: A clinical tool to calculate post-transplant survival using pre-transplant clinical characteristics in adults with cystic fibrosis.
abstract: We previously identified factors associated with a greater risk of death post-transplant. The purpose of this study was to develop a clinical tool to estimate the risk of death after transplant based on pre-transplant variables.
  
  
  
  We utilized the Canadian CF registry to develop a nomogram that incorporates pre-transplant clinical measures to assess post-lung transplant survival. The 1-, 3-, and 5-year survival estimates were calculated using Cox proportional hazards models.
  
  
  
  Between 1988 and 2012, 539 adult Canadians with CF received a lung transplant with 208 deaths in the study period. Four pre-transplant factors most predictive of poor post-transplant survival were older age at transplantation, infection with B. cepacia complex, low FEV1percent predicted, and pancreatic sufficiency. A nonlinear relationship was found between risk of death and FEV1percent predicted, age at transplant, and BMI. We constructed a risk calculator based on our model to estimate the 1-, 3-, and 5-year probability of survival after transplant which is available online.
  
  
  
  Our risk calculator quantifies the risk of death associated with lung transplant using pre-transplant factors. This tool could aid clinicians and patients in the decision-making process and provide information regarding the timing of lung transplantation.
authors.affiliation: Adult CF Program, St. Michael's Hospital, Toronto, ON, Canada.|Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: Adult CF Program, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Jenna
authors.initials: J
authors.lastname: Sykes
authors.affiliation: IRCM and Department of medicine, CHUM University of Montreal, Montreal, QC, Canada.
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthiaume
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.|Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.affiliation: Adult CF Program, St. Michael's Hospital, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, ON, Canada.|Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.affiliation: The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
authors.affiliation: The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.|Desautels Faculty of Management, McGill University, Montreal, Canada.
authors.forename: George Alex
authors.initials: GA
authors.lastname: Whitmore
authors.affiliation: Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stanojevic
mesh_terms: D000293:Adolescent; D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: cystic fibrosis; lung transplantation; nomogram; prediction model; survival; web-based application