Hayes Don, Sweet Stuart C, Benden Christian, Kopp Benjamin T, Goldfarb Samuel B, Visner Gary A, Mallory George B, Tobias Joseph D, Tumin Dmitry
Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
Transpl Int. 2017 Apr;30(4):371-377. doi: 10.1111/tri.12911. Epub 2017 Feb 17.
Transplant volume represents lung transplant (LTx) expertise and predicts outcomes, so we sought to determine outcomes related to center volumes in cystic fibrosis (CF). United Network for Organ Sharing data were queried for patients with CF in the United States (US) receiving bilateral LTx from 2005 to 2015. Multivariable Cox regression was used to model survival to 1 year and long-term (>1 year) survival, conditional on surviving at least 1 year. A total of 2025 patients and 67 centers were included in the analysis. The median annual LTx volumes were three in CF [interquartile range (IQR): 2, 6] and 17 in non-CF (IQR: 8, 33). Multivariable Cox regression in cases with complete data and surviving at least 1 year (n = 1510) demonstrated that greater annual CF LTx volume (HR per 10 LTx = 0.66; 95% CI: 0.49, 0.89; P = 0.006) but not greater non-CF LTx volume (HR = 1.00; 95% CI: 0.96, 1.05; P = 0.844) was associated with improved long-term survival in LTx recipients with CF. A Wald interaction test confirmed that CF LTx volume was more strongly associated with long-term outcomes than non-CF LTx volume (P = 0.012). In a US cohort, center volume was not associated with 1-year survival. CF-specific expertise predicted improved long-term outcomes of LTx for CF, whereas general LTx expertise was unassociated with CF patients' survival.
移植量代表肺移植（LTx）专业水平并可预测预后，因此我们试图确定与囊性纤维化（CF）患者中心移植量相关的预后情况。查询了器官共享联合网络中2005年至2015年在美国接受双侧LTx的CF患者的数据。采用多变量Cox回归模型对1年生存率和长期（>1年）生存率进行建模，条件是至少存活1年。分析共纳入2025例患者和67个中心。CF患者每年LTx量的中位数为3例[四分位间距（IQR）：2，6]，非CF患者为17例（IQR：8，33）。对数据完整且至少存活1年的病例（n = 1510）进行多变量Cox回归分析显示，CF患者每年LTx量增加（每10例LTx的风险比[HR]=0.66；95%置信区间[CI]：0.49，0.89；P = 0.006）与LTx受者长期生存率提高相关，但非CF患者LTx量增加（HR = 1.00；95%CI：0.96，1.05；P = 0.844）与长期生存率提高无关。Wald交互检验证实，CF患者的LTx量比非CF患者的LTx量与长期预后的相关性更强（P = 0.012）。在美国队列中，中心移植量与1年生存率无关。CF特异性专业水平可预测CF患者LTx的长期预后改善，而一般LTx专业水平与CF患者的生存率无关。
