Don Hayes1,2,3,4,5, Benjamin T Kopp6,7,8, Stephen E Kirkby6,9,7,8, Susan D Reynolds6,10, Heidi M Mansour11, Joseph D Tobias12,7,13, Dmitry Tumin6,7,13. 1. Departments of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA. hayes.705@osu.edu. 2. Departments of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu. 3. Departments of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu. 4. Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA. hayes.705@osu.edu. 5. Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. hayes.705@osu.edu. 6. Departments of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA. 7. Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA. 8. Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. 9. Departments of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. 10. Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA. 11. The University of Arizona-Tucson College of Pharmacy and College of Medicine, Tucson, AZ, USA. 12. Departments of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA. 13. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Abstract
INTRODUCTION: Donor PaO2 levels are used for assessing organs for lung transplantation (LTx), but survival implications of PaO2 levels in adult cystic fibrosis (CF) patients receiving LTx are unclear. METHODS: UNOS registry data spanning 2005-2013 were used to test for associations of donor PaO2 with patient survival and bronchiolitis obliterans syndrome (BOS) in adult (age ≥ 18 years) first-time LTx recipients diagnosed with CF. RESULTS: The analysis included 1587 patients, of whom 1420 had complete data for multivariable Cox models. No statistically significant differences among donor PaO2 categories of ≤200, 201-300, 301-400, or >400 mmHg were found in univariate survival analysis (log-rank test p = 0.290). BOS onset did not significantly differ across donor PaO2 categories (Chi-square p = 0.480). Multivariable Cox models of patient survival supported the lack of difference across donor PaO2 categories. Interaction analysis found a modest difference in survival between the two top categories of donor PaO2 when examining patients with body mass index (BMI) in the lowest decile (≤16.5 kg/m(2)). CONCLUSIONS: Donor PaO2 was not associated with survival or BOS onset in adult CF patients undergoing LTx. Notwithstanding statistically significant interactions between donor PaO2 and BMI, there was no evidence of post-LTx survival risk associated with donor PaO2 below conventional thresholds in any subgroup of adults with CF.
INTRODUCTION:DonorPaO2 levels are used for assessing organs for lung transplantation (LTx), but survival implications of PaO2 levels in adult cystic fibrosis (CF) patients receiving LTx are unclear. METHODS: UNOS registry data spanning 2005-2013 were used to test for associations of donorPaO2 with patient survival and bronchiolitis obliterans syndrome (BOS) in adult (age ≥ 18 years) first-time LTx recipients diagnosed with CF. RESULTS: The analysis included 1587 patients, of whom 1420 had complete data for multivariable Cox models. No statistically significant differences among donorPaO2 categories of ≤200, 201-300, 301-400, or >400 mmHg were found in univariate survival analysis (log-rank test p = 0.290). BOS onset did not significantly differ across donorPaO2 categories (Chi-square p = 0.480). Multivariable Cox models of patient survival supported the lack of difference across donorPaO2 categories. Interaction analysis found a modest difference in survival between the two top categories of donorPaO2 when examining patients with body mass index (BMI) in the lowest decile (≤16.5 kg/m(2)). CONCLUSIONS:DonorPaO2 was not associated with survival or BOS onset in adult CFpatients undergoing LTx. Notwithstanding statistically significant interactions between donorPaO2 and BMI, there was no evidence of post-LTx survival risk associated with donorPaO2 below conventional thresholds in any subgroup of adults with CF.
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