A new U.S. study found that lung transplants did not prolong life for the majority of children studied who had cystic fibrosis compared with CF children who did not undergo lung transplants. However, critics suggest the conclusions may no longer apply because in the US there is a new system for selecting young CF patients for transplants.
The study is the work of lead author Dr Theodore G Liou, associate professor of medicine at the University of Utah School of Medicine in Salt Lake City, and is published in the November issue of the New England Journal of Medicine.
Liou and colleagues studied 514 patients with CF who were under the age of 18 when they joined a waiting list for lung transplants. The researchers got clinical information on the patients from the CF Foundation national patient registry and the United Network for Organ Sharing. The children were on a waiting list for lung transplants between 1992 and 2002.
The results showed that:
- A total of 248 of the 514 children had a lung transplant in the US between 1992 and 2002.
- A statistical method called proportional-hazards modeling identified four variables besides transplantation that were linked with changes in survival.
- Burkholderia cepacia infection decreased survival, whether patients had transplants or not.
- A diagnosis for diabetes before going on the waiting list decreased survival while the patient was on the waiting list, but not after transplant.
- Being older did not affect waiting list survival but decreased post-transplant survival.
- Infection with staphylococcus aureus increased waiting-list survival but decreased post-transplant survival.
- Estimating the effect of tranplant on survival based on age, diabetes status and infection with S. aureus status, revealed that only five patients benefitted, while 315 had a significant risk of harm.
