Developing Cystic Fibrosis Lung Transplant Referral Criteria

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Developing Cystic Fibrosis Lung Transplant Referral

Criteria Using Predictors of 2-Year Mortality

Mayer-Hamblett, Margaret Rosenfeld,

Emerson, H. Goss and Moira L. Aitken

Departments of Pediatrics and Medicine, University of

Washington; and Statistical Analysis Unit, Cystic

Fibrosis Therapeutics Development Network Coordinating

Center, Children's Hospital and Regional Medical

Center, Seattle, Washington

Correspondence: Correspondence and requests for

reprints should be addressed to Mayer-Hamblett,

Ph.D., Department of Pediatrics, University of

Washington, 4800 Sand Point Way N.E., Box 5371, CL-11,

Seattle, WA 98105-0371. E-mail: nhambl@...

The first objective of our study was to develop a

model identifying the best clinical predictors of

2-year mortality among patients with cystic fibrosis

(CF), to assist in selection of appropriate candidates

for lung transplantation. Using multivariate logistic

regression, we found that age, height, FEV1,

respiratory microbiology, number of hospitalizations

for pulmonary exacerbations, and number of home

intravenous antibiotic courses were all significant

predictors of 2-year mortality among 14,572 patients

in the Cystic Fibrosis Foundation National Patient

Registry who were 6 years of age or older in 1996.

The second objective was to compare the diagnostic

accuracy of our model when used to guide referral for

lung transplant with that of the widely used criterion

of an FEV1 of less than 30% predicted. Surprisingly,

this well-fitting model derived from the largest

collection of data available on patients with CF

provided no better diagnostic accuracy than the

simpler FEV1 criterion. Both had high negative

predictive values (98 and 97%, respectively) but only

modest positive predictive values (33 and 28%,

respectively). Transplant referral decisions based

either on a multivariate logistic model or on the

criterion of an FEV1 of less than 30% predicted are

likely to result in high rates of premature referral.

Better clinical predictors of short-term mortality

among patients with CF are needed.

Becki

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