In Reply: We appreciate Mr Maish's comments
about our work and the important issue of quality of life (QOL). We found
that only the sickest patients with CF had a survival benefit from lung transplantation.
To answer Maish's specific question, we previously examined the apparent superior
survival of transplanted patients from group 1 compared with groups 2 and
3 (Figure 1 in our article) and found no statistical difference.
The greater issue is his concern that physicians might lose sight of
the toll that CF has on QOL. The principle primum non nocere (first, do no
harm) requires physicians to consider risks before recommending any procedure.
Our study provides the first estimate of survival risks and benefits of lung
transplantation for patients with CF stratified by predicted survival. We
focused on survival because it is an indisputable end point for measuring
the benefit of therapy.
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