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Priorities for Lung Transplantation Among Patients With Cystic Fibrosis

Theodore G. Liou, MD; Frederick R. Adler, PhD; Barbara C. Cahill, MD; Stacey C. FitzSimmons, PhD; David Huang, DPH; Jonathan R. Hibbs, MD; Bruce C. Marshall, MD
JAMA. 2002;287(12):1523-1525. doi:10.1001/jama.287.12.1523.
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To the Editor: In her Editorial accompanying our article1 about prognostic factors for lung transplantation among patients with cystic fibrosis (CF), Dr Maurer2 noted that we did not comment on the survivorship effect of the rate of change in the FEV1%.

We, like others,35 initially made the logical assumption that patients with CF who have rapid deterioration of FEV1% would have an increased risk of death. It has been hypothesized that the subset of patients with the most rapid decline in FEV1% would gain a survival benefit from lung transplantation. We created theoretical survival models based on this hypothesis that suggested that we might be able to identify appropriate transplantation candidates several years before the optimal moment for transplantation. This would decrease the number of patients who die while on a waiting list, and optimize the use of donated organs. Unfortunately, none of these models are valid because we also found that the rate of decline in FEV1% is not a significant predictor of survival.6

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Figure. Relationship Between FEV1% Predicted Rate of Change, 1987-1992 and 1993-1997 [N = 12 477]
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