Abstract
Introduction France implemented a high emergency lung transplantation (HELT) program nationally in 2007. A similar program 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 program 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 transplant increased in France after the HELT program was initiated (4.5% versus 10.1%) whereas deaths pre-transplant decreased from 85.3% in the pre-HELT to 57.1% in the post-HELT period. Between 2008–2016, 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 to Canada. Post-transplant survival was similar between the countries and there was no difference in survival when comparing pre- and post-HELT period in France.
Conclusion Following the implementation of the HELT program, 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 to the pre-HELT period, despite potentially sicker patients being transplanted, and is comparable to Canada.
Footnotes
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Conflict of interest: Dr. Coriati has nothing to disclose.
Conflict of interest: Ms. Sykes has nothing to disclose.
Conflict of interest: Dr. LEMONNIER has nothing to disclose.
Conflict of interest: Ms. Ma has nothing to disclose.
Conflict of interest: Dr. Stanojevic has nothing to disclose.
Conflict of interest: Dr. DEHILLOTTE has nothing to disclose.
Conflict of interest: Dr. Carlier reports non-financial support from NOVARTIS, non-financial support from MYLAN, non-financial support from THERAKOS, outside the submitted work.
Conflict of interest: Dr. Stephenson reports other from Cystic Fibrosis Canada, outside the submitted work.
Conflict of interest: Dr. Burgel reports personal fees from Astra-Zeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, grants and personal fees from GSK, personal fees from Insmed, personal fees from Novartis, personal fees from Pfizer, grants and personal fees from Vertex, personal fees from Teva, personal fees from Zambon, outside the submitted work.
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- Received January 4, 2021.
- Accepted June 3, 2021.
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