Age at lung transplant impacts long-term survival of patients with cystic fibrosis
Patients with cystic fibrosis aged 30 years and older at the time of lung transplant had superior long-term survival compared with younger patients, according to a study published in Annals of the American Thoracic Society.
“The findings from this study using the national United Network for Organ Sharing database are a good opportunity for us to investigate the factors that contribute to the discrepancies in the outcomes between the two groups of patients with cystic fibrosis,” Nirmal S. Sharma, MD, co-medical director at the lung transplant program at Brigham and Women’s Hospital at Harvard Medical School, told Healio. “It is possible that some of the risk factors may be modifiable and can help improve the long-term survival in the younger cohort.”
Previous studies have reported inferior posttransplant outcomes in pediatric patients with cystic fibrosis compared with adult patients with cystic fibrosis, according to the researchers.
Sharma and colleagues assessed the United Network for Organ Sharing (UNOS) registry and obtained information on 3,881 adults (mean age, 31 years) with cystic fibrosis who underwent lung transplantation from 1992 to 2016. Patients were separated into two groups based on age at lung transplant: age 18 to 29 years (n = 2,002) and age 30 years and older (n = 1,879).
Primary endpoint was survival time after lung transplant. Patients with cystic fibrosis aged at least 30 years had significantly higher survival compared with those aged 18 to 29 years at the time of transplant. Median survival was 9.47 years in the older cohort vs. 5.21 years in the younger cohort, according to the data. This survival analysis remained higher in the older group after the researchers adjusted for confounders (HR = 0.44; 95% CI, 0.2-0.9).
Death due to allograft failure was significantly lower among patients aged at least 30 years (28%) vs. those aged 18 to 29 years (36.5%; OR = 0.7; 95% CI, 0.6-0.8). Researchers noted a higher incidence of malignancy in patients aged at least 30 years (8%) vs. those aged 18 to 29 years (2.9%; OR = 3; 95% CI, 1.9-4.6).
“Currently, we are not changing our practice of transplanting patients with cystic fibrosis based on recipient age at transplant,” Sharma told Healio. “Prospective studies are needed to further identify these risk factors that contribute to the lower long-term survival seen in the 18- to 29-year-old patients with cystic fibrosis. Our ongoing studies are currently investigating some of these aspects.”
For more information:
Nirmal S. Sharma, MD, can be reached at nsharma21@bwh.harvard.edu.