A gloomy view of lung transplants

The Baltimore Sun

Lung transplants - a treatment of last resort for cystic fibrosis - are rarely beneficial to children with that condition and are often harmful, according to a study released last week.

Among 248 children who received a lung transplant over an 11-year period, only one clearly benefited while 167 were at a higher risk of dying after the procedure, Utah researchers reported in the New England Journal of Medicine.

Dr. Julian Allen of Children's Hospital of Philadelphia called the findings "startling" in an editorial in the journal. He said the study made it clear that "although transplantation may improve quality of life, it may not improve survival."

But Dr. Vaughn Starnes of Children's Hospital Los Angeles said he "vehemently disagrees" with the report's conclusions. He believed the researchers got bad results because they lumped together data from hospitals that specialize in transplants in children and those that specialize in adults.

"Our children are deriving a significant benefit in survival," Starnes said. "We have patients who are alive 12 to 14 years out after the procedure."

Cystic fibrosis is a genetic defect that affects about 30,000 Americans. It causes a buildup of mucus in many organs, particularly the lungs and the pancreas. In the lungs, the mucus makes breathing progressively more difficult.

A half-century ago, most children with the disorder died in their first year or two of life. Today, the median life expectancy is 36 years, according to the Cystic Fibrosis Foundation.

Studies of adults have shown that lung transplants can prolong life, but previous studies of children have been mixed.

A British study of 47 children showed that the procedure improved survival, but an earlier U.S. study led by Dr. Theodore G. Liou at the University of Utah showed no benefit.

To provide a more definitive understanding of benefits and risks, Liou's team expanded its study to 514 children on the U.S. waiting list for lung transplants from 1992 through 2002. Of those, 248 actually underwent the procedure, with 33 percent of them surviving for at least five years.

Analyzing at least 26 different health variables, researchers concluded that only one of the 248 who received a transplant benefited from it.

The study results predate a 2005 change that awards donor lungs to the sickest patients rather than those who have been waiting the longest.

The change may lead to a higher success rate for the procedure, said Dr. Preston Campbell of Johns Hopkins Hospital, who is also executive vice president for medicine at the Cystic Fibrosis Foundation, which funded the study.

Thomas H. Maugh II writes for the Los Angeles Times.

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