Lung transplant rarely prolongs life in CF

Lung transplant rarely prolongs life in CF
NEW YORK (Reuters Health) - Lung transplantation inchildren with cystic fibrosis (CF) is not likely to prolonglife and may do more harm than good, according to a look backat essentially the entire U.S. pediatric experience with lungtransplantation for cystic fibrosis for the period 1992 through2002.
According to a report in November 22 issue of The NewEngland Journal of Medicine, a total of 248 of the 514 childrenwith cystic fibrosis who were on the waiting list during the10-year-period underwent lung transplantation.
"Children undergoing lung transplant did much worse thanexpected," Dr. Theodore G. Liou of the University of Utah, SaltLake City, told Reuters Health.
"We fully expected, at the start of the study, that wewould find a group that did well and others that did not do sowell. Unfortunately, we found that the group that most likelydid well with transplant was very small, while the group thatmost likely did poorly (worse than if not transplanted) wasquite large," Liou said.
Specifically, analyses showed that only five children had asignificant estimated benefit associated with lungtransplantation. The majority of children -- 315 to be exact --were at significant risk for harm from lung transplant, whilefor 194 children, the procedure was not clearly harmful orbeneficial.
"Our paper essentially points out how difficult it is tofind the patients most likely to die soon and thus most likelyto have a survival increase by transplantation," Liou said.
"One possible reason why there doesn't seem to be muchsurvival benefit would be that conventional therapy for cysticfibrosis has gotten so good that children with cystic fibrosisare simply no longer dying," Liou suggested. "Therefore, alifesaving operation is not only unneeded but not possible.Improvements in cystic fibrosis care have been steady andremarkably effective."
"We are not trying to eliminate the procedure or take awaythe last bit of hope for desperately ill children with CF,"Liou emphasized. "We are trying very hard to look critically atthis therapy and identify how we could make it better."
Liou also noted that the data used for the study are notsufficient to make a statement about quality of life forchildren who have a lung transplant and how it compares toquality of life without one.
"We think that some sort of study to collect the rightinformation to allow simultaneous assessment of the effects onsurvival and quality of life in the same patient is needed,"Liou said.
SOURCE: The New England Journal of Medicine, November 22,2007.