Outcomes following lung re-transplantation in patients with cystic fibrosis |
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| Institution: | 1. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States;2. Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Pittsburgh, Pittsburgh, PA, United States;1. Dept of Respiratory Medicine, The Children''s Hospital at Westmead, Respiratory Medicine, Locked Bag 4001, Westmead, Sydney, Australia;2. Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia;3. Translational Medicine, Division of Respiratory Medicine, Sellers Chair of Cystic Fibrosis, Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1 × 8, Canada;4. Dept of Community Health and Epidemiology, Dalhousie University, Halifax, Canada;5. National Heart and Lung Institute, Imperial College London, United Kingdom;6. Royal Brompton Hospital, Guys & St Thomas’ NHS Foundation Trust, London, United Kingdom;7. University of Toronto, Toronto, Canada;1. Louvain Center for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique;2. Cystic Fibrosis Center, Belgium;3. Medicinal Chemistry Research Lab, Louvain Drug Research Institute;4. Advanced Drug Delivery & Biomaterials, Louvain Drug Research Institute;5. Université catholique de Louvain (UCLouvain), Brussels, Belgium;6. Katholieke Universiteit Leuven (UZLeuven), Leuven, Belgium;1. Cystic Fibrosis Centre, Department of Gastroenterology and Transplantation, United Hospitals, Ancona, Italy;2. Department of Women''s and Children''s Health, University of Liverpool, Liverpool, UK;3. Children''s Hospital of Eastern Switzerland, St. Gallen, Switzerland;4. CF Centre, Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium;5. CF centre, Necker-Enfants Malades Hospital, AP-HP Paris Centre University, France;6. Hadassah Hebrew University Medical Center, Jerusalem, Israel;7. Laboratories of Biochemistry and of the Regional Newborn Screening, Necker-Enfants Malades Hospital, AP-HP Paris Centre University, France;8. Clinical Department of Laboratory Diagnostics, Clinical Hospital Center Rijeka, Rijeka, Croatia;9. Adult Cystic Fibrosis Centre, Royal Brompton Hospital and Imperial College, London, UK;10. CF centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium;1. Clinical Head: Cystic Fibrosis Clinic Red Cross War Memorial Children''s Hospital, National Director South African CF Registry Steering Committee, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa;2. Laboratory of Genetic Epidemiology Research Centre for Medical Genetics, Moscow Regional Research and Clinical Institute, President of All-Russian Association For Patients With Cystic Fibrosis, Moscow, Russian Federation;3. Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey;4. Pediatric Pulmonology Unit, Instituto da Criança HCFMUSP, Sao Paulo, Brazil;5. Division of Pulmonary and Sleep Medicine, Nationwide Children''s Hospital, The Ohio State University, Columbus, OH, United States of America;6. Middle East Cystic Fibrosis Association CEO of (MECFA), United States of America;1. University of Dublin Trinity College, Dublin, Ireland;2. University Hospital Limerick, Dooradoyle, Limerick, Ireland;3. Children''s Health Ireland at Temple Street and Crumlin Hospitals, Dublin, Ireland;4. Tallaght University Hospital, Dublin, Ireland;5. School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland;6. National Children''s Research Centre, Crumlin, Dublin, Ireland |
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| Abstract: | PurposeWe examined cystic fibrosis (CF) patients and compared their clinical status at the time of primary versus double lung re-transplantation (re-DLTx) in order to better understand lung retransplant practice patterns.MethodsWe performed a retrospective analysis of the UNOS Database identifying CF patients ≥18 years old undergoing re-DLTx (5/4/2005 and 12/4/2020). Baseline and clinical variables at the primary and re-DLTx were compared utilizing the paired student t-test. Graft survival was defined as time from surgery to retransplant and analyzed using Kaplan-Meier estimates.Results277 CF patients who underwent re-DLTx experienced a significantly worse 5-year survival when compared to the primary DLTx cohort (47.9% vs 58.8%, p = 0.00012). The following differences were observed comparing CF re-DLTx group to their primary DLTx: higher LAS score at the time of listing (50.66 vs 42.15, p < 0.001) and transplant (62.19 vs 48.20, p < 0.001), and increase LAS from the time of listing to transplant (+12.22 vs +7.23, p = 0.002). While serum albumin and total bilirubin were similar, CF patients had a higher creatinine (1.05 vs 0.74, p < 0.001), dialysis (4.4% vs 0.6%, p < 0.001), ECMO bridge to transplant rates (7.6% vs 4.0%, p < 0.001), and higher oxygen requirements (5.95 vs 3.93, p < 0.001) at the time of listing for a re-DLTx.ConclusionCompared to their initial transplant, CF patients experience significant clinical decline in renal, cardiac, and pulmonary function at the time of lung retransplantation. This may indicate that an earlier evaluation and rehabilitation process may be necessary to identify patients earlier for lung retransplantation prior significant clinical decline. |
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