Lung transplantation in cystic fibrosis patients in Israel: The importance of ethnicity and nutritional status

Clin Transplant. 2017 Nov;31(11). doi: 10.1111/ctr.13111.

Abstract

Objectives: To assess the characteristics that correlate with better outcomes after lung transplantation for patients with cystic fibrosis (CF).

Methods: We retrospectively reviewed the charts of all patients with CF who underwent lung transplantation between 1996 and 2014 at Rabin Medical Center, Israel.

Results: Fifty patients with CF underwent 55 lung transplantations. Eighteen patients (36%) died during the study period. Actuarial survival was 83%, 68%, 62%, and 39% at 1, 3, 5, and 10 years, respectively. Better survival correlated with: BMI at 6 months and 1 year after transplantation (P = .002 and P = .003, respectively), ischemic time of less than 300 minutes (P = .023), absence of liver disease (P = .012), and Jewish compared to Arab ethnicity (P = .007). Freedom from bronchiolitis obliterans syndrome (BOS) was 87%, 75%, and 72% at 1, 3, and 5 years, respectively. BOS was more common and appeared earlier in the Arab than in the Jewish population (P = .012, P = .007). Additionally, prolonged time free of BOS correlated with male gender (P = .039), older age (P < .001), absence of liver disease (P = .012), and higher BMI 1 year after transplantation (P < .001).

Conclusions: Clinically important determinants for survival include BMI pre- and 1-year post-transplantation and improved freedom from BOS. Arab ethnicity correlated with higher incidence and earlier onset of BOS compared to Jewish ethnicity in Israel.

Keywords: bronchiolitis obliterans; cystic fibrosis; lung transplantation; pulmonary outcome.

MeSH terms

  • Adolescent
  • Adult
  • Bronchiolitis Obliterans / etiology*
  • Bronchiolitis Obliterans / mortality
  • Child
  • Cystic Fibrosis / ethnology
  • Cystic Fibrosis / surgery*
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Graft Rejection / etiology*
  • Graft Rejection / mortality
  • Graft Survival
  • Humans
  • Israel
  • Lung Transplantation / adverse effects*
  • Lung Transplantation / mortality
  • Male
  • Middle Aged
  • Nutritional Status*
  • Postoperative Complications
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Young Adult