Anne L Stephenson1, Jenna Sykes2, Yves Berthiaume3, Lianne G Singer4, Shawn D Aaron5, George A Whitmore6, Sanja Stanojevic7. 1. Adult CF Program, St. Michael's Hospital, Toronto, Ontario; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: stephensona@smh.ca. 2. Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario. 3. Institut de Recherches Cliniques de Montréal and Centre hospitalier de l'Université de Montréal, Montreal, Quebec. 4. Department of Medicine, University of Toronto, Toronto, Ontario; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario. 5. The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario. 6. The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario; Desautels Faculty of Management, McGill University, Montreal, Quebec. 7. Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Contemporary studies evaluating post-transplant survival are limited and often include data from single centers or selected sub-groups. The purpose of this study was to evaluate overall transplant survival and to identify risk factors associated with death after transplant. METHODS: The Canadian Cystic Fibrosis Registry, a population-based cohort, was used to describe survival after lung transplant. Pre-transplant factors associated with post-transplant survival were estimated using Cox proportional hazards models. RESULTS: Between 1988 and 2012, 580 patients received a lung transplant. In the entire cohort, post-lung transplant 1-year survival was 87.8%, 5-year survival was 66.7%, and 10-year survival was 50.2%. Median post-transplant survival was 3.3 years (95% confidence interval [CI] = 2.13-6.56) in patients infected with Burkholderia cepacia complex compared with 12.36 years (95% CI = 10.34-17.96) in patients without B cepacia infection (hazard ratio [HR] = 2.63, 95% CI = 2.0-3.44). After adjustment, there was a non-significant trend toward better post-transplant survival with increasing year of transplant (HR = 0.98, 95% CI = 0.96-1.00). Pancreatic sufficiency (HR = 2.13, 95% CI = 1.41-3.20) and age at transplant such that youngest and oldest had the poorest survival (p < 0.001) were significant negative predictors of survival. The risk of death after transplant for patients infected with B cepacia was highest within the first year (HR = 6.29, 95% CI = 3.87-10.21) but remained elevated >1 year after transplant (HR = 1.92, 95% CI = 1.33-2.77) compared with patients without B cepacia infection. CONCLUSIONS: After lung transplantation, 5-year survival in Canadians with CF is 67%, and 50% of patients live >10 years. Despite these impressive probabilities, age at transplant, pancreatic sufficiency and B cepacia infection remain important determinants of survival after lung transplantation.
BACKGROUND: Contemporary studies evaluating post-transplant survival are limited and often include data from single centers or selected sub-groups. The purpose of this study was to evaluate overall transplant survival and to identify risk factors associated with death after transplant. METHODS: The Canadian Cystic Fibrosis Registry, a population-based cohort, was used to describe survival after lung transplant. Pre-transplant factors associated with post-transplant survival were estimated using Cox proportional hazards models. RESULTS: Between 1988 and 2012, 580 patients received a lung transplant. In the entire cohort, post-lung transplant 1-year survival was 87.8%, 5-year survival was 66.7%, and 10-year survival was 50.2%. Median post-transplant survival was 3.3 years (95% confidence interval [CI] = 2.13-6.56) in patients infected with Burkholderia cepacia complex compared with 12.36 years (95% CI = 10.34-17.96) in patients without B cepacia infection (hazard ratio [HR] = 2.63, 95% CI = 2.0-3.44). After adjustment, there was a non-significant trend toward better post-transplant survival with increasing year of transplant (HR = 0.98, 95% CI = 0.96-1.00). Pancreatic sufficiency (HR = 2.13, 95% CI = 1.41-3.20) and age at transplant such that youngest and oldest had the poorest survival (p < 0.001) were significant negative predictors of survival. The risk of death after transplant for patients infected with B cepacia was highest within the first year (HR = 6.29, 95% CI = 3.87-10.21) but remained elevated >1 year after transplant (HR = 1.92, 95% CI = 1.33-2.77) compared with patients without B cepacia infection. CONCLUSIONS: After lung transplantation, 5-year survival in Canadians with CF is 67%, and 50% of patients live >10 years. Despite these impressive probabilities, age at transplant, pancreatic sufficiency and B cepacia infection remain important determinants of survival after lung transplantation.
Authors: Kathleen J Ramos; Patrick J Smith; Edward F McKone; Joseph M Pilewski; Amy Lucy; Sarah E Hempstead; Erin Tallarico; Albert Faro; Daniel B Rosenbluth; Alice L Gray; Jordan M Dunitz Journal: J Cyst Fibros Date: 2019-03-27 Impact factor: 5.482
Authors: Bradley S Quon; Jenna Sykes; Sanja Stanojevic; Bruce C Marshall; Kristofer Petren; Josh Ostrenga; Aliza Fink; Alexander Elbert; Albert Faro; Christopher H Goss; Anne L Stephenson Journal: Clin Transplant Date: 2018-02-11 Impact factor: 2.863
Authors: Kathleen J Ramos; Bradley S Quon; Kevin J Psoter; Erika D Lease; Nicole Mayer-Hamblett; Moira L Aitken; Christopher H Goss Journal: J Cyst Fibros Date: 2015-12-17 Impact factor: 5.482
Authors: Alyssa A Perez; Steven R Hays; Allison Soong; Ying Gao; John R Greenland; Lorriana E Leard; Rupal J Shah; Jeffrey Golden; Jasleen Kukreja; Aida Venado; Mary Ellen Kleinhenz; Jonathan P Singer Journal: Pediatr Pulmonol Date: 2020-04-01
Authors: Anne L Stephenson; Jenna Sykes; Sanja Stanojevic; Bradley S Quon; Bruce C Marshall; Kristofer Petren; Josh Ostrenga; Aliza K Fink; Alexander Elbert; Christopher H Goss Journal: Ann Intern Med Date: 2017-03-14 Impact factor: 25.391
Authors: Kathleen J Ramos; Jenna Sykes; Sanja Stanojevic; Xiayi Ma; Joshua S Ostrenga; Aliza Fink; Bradley S Quon; Bruce C Marshall; Albert Faro; Kristofer Petren; Alexander Elbert; Christopher H Goss; Anne L Stephenson Journal: Chest Date: 2021-04-17 Impact factor: 10.262
Authors: Kathleen J Ramos; Ranjani Somayaji; Erika D Lease; Christopher H Goss; Moira L Aitken Journal: BMC Pulm Med Date: 2017-01-19 Impact factor: 3.317
Authors: Anne L Stephenson; Kathleen J Ramos; Jenna Sykes; Xiayi Ma; Sanja Stanojevic; Bradley S Quon; Bruce C Marshall; Kristofer Petren; Joshua S Ostrenga; Aliza K Fink; Albert Faro; Alexander Elbert; Cecilia Chaparro; Christopher H Goss Journal: J Heart Lung Transplant Date: 2020-12-07 Impact factor: 10.247