Lung transplant is a widely accepted treatment for cystic fibrosis (CF) end-stage lung disease. The US lung allocation score (LAS) system prioritizes transplant candidates primarily based on calculated risk of waitlist mortality while avoiding futile transplants. Variables that increase risk of waitlist mortality increase the LAS and access to transplant. Variables that increase risk of posttransplant mortality decrease the LAS and access to transplant.

The Scientific Registry of Transplant Recipients (SRTR) identifies variables from the time of listing through the posttransplant period for all US transplant candidates and recipients. The CF Foundation Patient Registry (CFFPR), representing 84% of the US CF population, includes longitudinal variables for time before wait-listing.

We previously described that an absolute drop in FEV₁ ≥30% predicted in CF candidates in the year before listing is associated with a higher risk of waitlist death. The impact of FEV₁ drop on posttransplant mortality is unknown. We aimed to identify the association between FEV₁ drop and posttransplant mortality among lung transplant recipients with CF, using linked SRTR and CFFPR data.

Lung transplant recipients were identified in linked data. They entered the cohort at the time of lung transplant, 2006-2014, and were followed for 1 year. Cox regression models were used to identify risk factors for 1-year posttransplant mortality.

The matched dataset included 1853 CF lung transplant recipients aged ≥12 years, of whom 1627 (88%) were alive at 1 year. Table 1 presents the adjusted Cox regression model. An absolute drop of ≥20% predicted (between FEV₁ at transplant and the highest FEV₁ value in the pretransplant year) had a borderline association with increased posttransplant 1-year mortality (HR 1.36, 95% CI 0.99-1.86).

FEV₁ drop is a candidate variable for inclusion in the LAS since it identifies CF candidates at increased risk of waitlist mortality, and not necessarily posttransplant mortality. Inclusion may lead to improved access transplant for CF candidates.

CITATION INFORMATION: Dasenbrook E, Skeans M, Fink A, Marshall B, Valapour M. Addition of FEV1 Drop to LAS May Improve Access of CF Patients to Transplant: Analysis of the SRTR and US CF Foundation Patient Registries. Am J Transplant. 2017;17 (suppl 3).

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