Influence of graft ischemic time on survival in children with cystic fibrosis after lung transplantation.

The influence of graft ischemic time on survival after lung transplantation (LTx) in children with cystic fibrosis (CF) is not well studied. The United Network for Organ Sharing (UNOS) database was queried from May 2005 to September 2013 to examine the impact of ischemic time of <4, 4-6, and >6 hr in pediatric LTx recipients with CF. One hundred and ninety-nine patients with CF under 18 years of age that were first-time LTx recipients from cadaveric donors were included in the analysis. Compared to 4-6 hr, univariate analysis showed a significant increase in mortality hazard with an ischemic time of <4 hr (HR = 2.407; 95%CI: 1.292, 4.485; P = 0.006) but not >6 hr (HR = 1.350; 95%CI: 0.796, 2.290; P = 0.266). A Kaplan-Meier plot demonstrated the highest survival with 4-6 hr (Log-rank test P = 0.018) of ischemic time. Multivariate Cox model confirmed a significantly higher mortality risk with <4 hr (HR = 2.388; 95%CI: 1.169, 4.764; P = 0.014) and not >6 hr (HR = 1.407; 95%CI: 0.760, 2.605; P = 0.278) in relation to 4-6 hr. Sub-analysis examining ischemic time and the hazard of bronchiolitis obliterans syndrome with death as a competing risk found no significant differences in the hazard of this outcome across the three ischemic time categories. Ischemic time of 4-6 hr was associated with the highest long-term survival in first-time pediatric LTx recipients with CF, with ischemic time <4 hr related to diminished survival. Pediatr Pulmonol. 2016; 51:908-913. © 2016 Wiley Periodicals, Inc.

Hayes D Jr ，Tumin D ，Kopp BT ，Tobias JD ，Sheikh SI ，Kirkby SE ... -  《-》

Human leukocyte antigen mismatching and survival after lung transplantation in adult and pediatric patients with cystic fibrosis.

The influence of human leukocyte antigen (HLA) mismatching on survival in adult and pediatric patients with cystic fibrosis (CF) after lung transplantation (LTx) is unknown. The United Network for Organ Sharing database was queried from 1987 to 2013 to determine the influence of HLA mismatching on survival in adult and pediatric CF LTx recipients by assessing the association of HLA mismatching with survival in first-time adult (aged ≥ 18 years) and pediatric (aged <18 years) recipients. Of 3149 adult and 489 pediatric patients with CF, 3145 and 489 were used for univariate Cox analysis, 2687 and 363 for Kaplan-Meier survival analysis, and 2073 and 257 for multivariate Cox analysis, respectively. Univariate analyses in adult and pediatric patients with CF demonstrated conflicting associations between HLA mismatching and survival (adult hazard ratio [HR], 1.0; 95% confidence interval [CI], 0.97-1.1; P = .45 vs pediatric HR, 0.87; 95% CI, 0.77-0.99; P = .032). Multivariate Cox models including both pediatric and adult patients confirmed that HLA mismatching had an initially protective effect at young ages (HR, 0.85; 95% CI, 0.73-0.99; P = .044) and that this protective effect diminished at older ages and was no longer associated with survival at P < .05 beyond age 10 years. HLA mismatching has significantly different implications for survival after LTx in adult compared with pediatric patients with CF.

Hayes D Jr ，Auletta JJ ，Whitson BA ，Black SM ，Kirkby S ，Tobias JD ，Mansour HM ... -  《-》

Impact of Donor Arterial Partial Pressure of Oxygen on Outcomes After Lung Transplantation in Adult Cystic Fibrosis Recipients.

Hayes D Jr ，Kopp BT ，Kirkby SE ，Reynolds SD ，Mansour HM ，Tobias JD ，Tumin D ... -  《-》

Influence of diabetes on survival in patients with cystic fibrosis before and after lung transplantation.

The influence of diabetes mellitus (DM) on survival in patients with cystic fibrosis (CF) before and after lung transplantation is not well studied. To determine the influence of DM in patients with CF, the United Network for Organ Sharing database (2005-2013) was queried for 2 cohorts: first-time lung transplant candidates who were not transplanted and first-time transplant recipients. A total of 679 patients with CF had data on DM status at listing and did not undergo transplantation. In this cohort, DM was associated with significant increase in mortality hazard as shown by an adjusted multivariate Cox model fitted to the whole cohort (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.1-1.8; P = .012) and by a Cox model stratified on pairs of DM and non-DM patients matched on the propensity of having DM at listing (HR, 1.9; 95% CI, 1.2-2.9; P = .003). In comparison, a total of 1464 patients with CF had data on DM status at listing and received a transplant, but DM at listing was not associated with posttransplant survival. The lack of association between DM and mortality hazard was evident in a multivariate Cox regression model fitted to the whole sample (HR, 1.0; 95% CI, 0.82-1.2; P = .98) and a Cox regression model stratified on matched pairs of DM and non-DM patients (HR, 1.1; 95% CI, 0.82-1.5; P = .56). The presence of DM is associated with significantly increased risk for death in patients with CF on the wait list before lung transplantation, but does not influence survival after transplantation.

Hayes D Jr ，Patel AV ，Black SM ，McCoy KS ，Kirkby S ，Tobias JD ，Mansour HM ，Whitson BA ... -  《-》

Increased Mortality in Adult Cystic Fibrosis Patients with Medicaid Insurance Awaiting Lung Transplantation.

Krivchenia K ，Tumin D ，Tobias JD ，Hayes D Jr ... -  《-》