Abstract
Background France implemented a high emergency lung transplantation (HELT) programme nationally in 2007. A similar programme does not exist in Canada. The objectives of our study were to compare health outcomes within France as well as between Canada and France before and after the HELT programme in a population with cystic fibrosis (CF).
Methods This population-based cohort study utilised data from the French and Canadian CF registries. A cumulative incidence curve assessed time to transplant with death without transplant as competing risks. The Kaplan–Meier method was used to estimate post-transplant survival.
Results Between 2002 and 2016, there were 1075 (13.0%) people with CF in France and 555 (10.2%) people with CF in Canada who underwent lung transplantation. The proportion of lung transplants increased in France after the HELT programme was initiated (4.5% versus 10.1%), whereas deaths pre-transplant decreased from 85.3% in the pre-HELT period to 57.1% in the post-HELT period. Between 2008 and 2016, people in France were significantly more likely to receive a transplant (hazard ratio (HR) 1.56, 95% CI 1.37–1.77; p<0.001) than die (HR 0.55, 95% CI 0.46–0.66; p<0.001) compared with Canada. Post-transplant survival was similar between the countries, and there was no difference in survival when comparing pre- and post-HELT periods in France.
Conclusions Following the implementation of the HELT programme, people living with CF in France were more likely to receive a transplant than die. Post-transplant survival in the post-HELT period in France did not change compared with the pre-HELT period, despite potentially sicker patients being transplanted, and was comparable to Canada.
Abstract
A high emergency lung transplantation programme in the French cystic fibrosis population led to an increased number of lung transplants. Post-transplant survival was not changed despite sicker patients being transplanted and was comparable to Canada. https://bit.ly/2ScK7vv
Footnotes
This article has supplementary material available from erj.ersjournals.com
This article has an editorial commentary: https://doi.org/10.1183/13993003.02209-2021
Author contributions: A. Coriati: data acquisition and merging of data, interpretation, drafting, critical revision and editing of the manuscript. J. Sykes: data acquisition and merging of data, study design, interpretation, critical revision and editing of the manuscript. L. Lemonnier, X. Ma and C. Dehillotte: data acquisition and merging of data, interpretation, critical revision and editing of the manuscript. S. Stanojevic: interpretation, critical revision and editing of the manuscript. N. Carlier: interpretation of the data, critical revision and editing of the manuscript. A.L. Stephenson and P-R. Burgel: supervision, study design, project administration, interpretation of the data, critical revision and editing of the manuscript, funding acquisition. All authors approved the final version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Conflict of interest: A. Coriati has nothing to disclose.
Conflict of interest: J. Sykes has nothing to disclose.
Conflict of interest: L. Lemonnier has nothing to disclose.
Conflict of interest: X. Ma has nothing to disclose.
Conflict of interest: S. Stanojevic has nothing to disclose.
Conflict of interest: C. Dehillotte has nothing to disclose.
Conflict of interest: N. Carlier reports nonfinancial support from Novartis, Mylan and Therakos, outside the submitted work.
Conflict of interest: A.L. Stephenson is Medical Director of the Canadian Cystic Fibrosis Registry for Cystic Fibrosis Canada, outside the submitted work.
Conflict of interest: P-R. Burgel reports grants and personal fees from Boehringer Ingelheim, GSK and Vertex, personal fees from AstraZeneca, Chiesi, Insmed, Novartis, Pfizer, Teva and Zambon, outside the submitted work.
Support statement: We would like to acknowledge the support of the Cystic Fibrosis Canada research grant held by A.L. Stephenson and the Vaincre la Mucoviscidose research grant held by P-R. Burgel, which made this study possible. A. Coriati was supported by a postdoctoral fellowship from the Canadian Lung Association. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received January 4, 2021.
- Accepted June 3, 2021.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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