Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis.

Details

Serval ID
serval:BIB_39C08E71404C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis.
Journal
Journal of cystic fibrosis
Author(s)
Koutsokera A., Varughese R.A., Sykes J., Orchanian-Cheff A., Shah P.S., Chaparro C., Tullis E., Singer L.G., Stephenson A.L.
ISSN
1873-5010 (Electronic)
ISSN-L
1569-1993
Publication state
Published
Issued date
05/2019
Peer-reviewed
Oui
Volume
18
Number
3
Pages
407-415
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Mortality risk stratification is essential in lung transplantation (LTx) to allow listing, prioritization and mitigating strategies. In cystic fibrosis (CF) patients, predictors of post-LTx mortality are not established.
For this systematic review and meta-analysis, seven databases were searched until January 3, 2018 to identify predictors of post-LTx mortality in CF. We excluded studies of multi-organ transplantation, re-transplantation and graft survival. For multiple studies assessing the same population during overlapping time-periods, the largest one was analyzed. Risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Pooled hazard ratios were calculated using random-effects models.
Fifty-four studies were included in the systematic review and 11 studies in the meta-analyses (low-to-moderate bias risk, NOS score ≥ 5). Among 10 factors assessed in the meta-analysis, B. cepacia complex (BCC) (N = 1451, unadjusted HR = 2.35, 95%CI:1.80-3.06; I <sup>2</sup>  = 20.4% and adjusted HR = 2.49, 95%CI:1.74-3.57; I <sup>2</sup>  = 46.2%) and ascending chronological year of LTx (N = 4207, unadjusted HR = 0.98, 95%CI:0.97-0.98, I <sup>2</sup>  = 4.8%) were predictors of post-LTx mortality. Male gender (N = 2903, adjusted HR = 1.12, 95%CI:1.0-1.26, I <sup>2</sup>  = 0%) and age in adults (N = 3677, unadjusted HR = 0.99, 95%CI:0.97-1.00; I <sup>2</sup>  = 64.1% and N = 2605, adjusted HR = 0.98, 95%CI:0.97-0.99; I <sup>2</sup>  = 34.3%) had borderline significant associations with post-LTx mortality. P. aeruginosa colonization, forced expiratory volume in one second (FEV <sub>1</sub> ), pulmonary hypertension, body mass index (BMI), pancreatic insufficiency and CF-related diabetes (CFRD) were not predictors of mortality.
BCC was associated with a higher post-LTx mortality whereas FEV <sub>1</sub> , pulmonary hypertension, BMI, CFRD and female gender were not associated with post-LTx mortality. These findings indicate that CF-specific risk estimates of post-LTx mortality should be considered.
Keywords
Cystic fibrosis, Lung transplantation, Mortality, Predictors
Pubmed
Web of science
Create date
14/12/2018 12:18
Last modification date
26/08/2019 23:27
Usage data