弥合囊性纤维化患者的生存差距：对加拿大和美国肺移植结果的调查。
Bridging the survival gap in cystic fibrosis: An investigation of lung transplant outcomes in Canada and the United States.
机构信息
Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
出版信息
J Heart Lung Transplant. 2021 Mar;40(3):201-209. doi: 10.1016/j.healun.2020.12.001. Epub 2020 Dec 7.
BACKGROUND
Previous literature in cystic fibrosis (CF) has shown a 10-year survival gap between Canada and the United States (US). We hypothesized that differential access to and survival after lung transplantation may contribute to the observed gap. The objectives of this study were to compare CF transplant outcomes between Canada and the US and estimate the potential contribution of transplantation to the survival gap.
METHODS
Data from the Canadian CF Registry and the US Cystic Fibrosis Foundation Patient Registry supplemented with data from United Network for Organ Sharing were used. The probability of surviving after transplantation between 2005 and 2016 was calculated using the Kaplan‒Meier method. Survival by insurance status at the time of transplantation and transplant center volume in the US were compared with those in Canada using Cox proportional hazard models. Simulations were used to estimate the contribution of transplantation to the survival gap.
RESULTS
Between 2005 and 2016, there were 2,653 patients in the US and 470 in Canada who underwent lung transplantation for CF. The 1-, 3-, and 5-year survival rates were 88.3%, 71.8%, and 60.3%, respectively, in the US compared with 90.5%, 79.9%, and 69.7%, respectively, in Canada. Patients in the US were also more likely to die on the waitlist (p < 0.01) than patients in Canada. If the proportion of who underwent transplantation and post-transplant survival in the US were to increase to those observed in Canada, we estimate that the survival gap would decrease from 10.8 years to 7.5 years.
CONCLUSIONS
Differences in waitlist mortality and post-transplant survival can explain up to a third of the survival gap observed between the US and Canada.
背景
先前关于囊性纤维化 (CF) 的文献表明，加拿大和美国之间存在长达 10 年的生存差距。我们假设，肺移植后的获得机会和生存差异可能导致了这一差距。本研究的目的是比较加拿大和美国的 CF 移植结果，并评估移植对生存差距的潜在贡献。
方法
使用加拿大 CF 登记处和美国 CF 基金会患者登记处的数据，并辅以美国器官共享网络的数据。使用 Kaplan-Meier 方法计算 2005 年至 2016 年移植后的生存概率。使用 Cox 比例风险模型比较移植时的保险状况和美国移植中心的容量与加拿大的情况。使用模拟来估计移植对生存差距的贡献。
结果
在 2005 年至 2016 年期间，美国有 2653 名患者和加拿大有 470 名患者因 CF 接受肺移植。美国的 1 年、3 年和 5 年生存率分别为 88.3%、71.8%和 60.3%，而加拿大分别为 90.5%、79.9%和 69.7%。与加拿大相比，美国的患者在等待名单上死亡的可能性也更高 (p < 0.01)。如果美国的移植比例和移植后生存率提高到加拿大的水平，我们估计生存差距将从 10.8 年缩小到 7.5 年。
结论
等待名单死亡率和移植后生存率的差异可以解释美国和加拿大之间观察到的生存差距的三分之一。
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