The guidelines adopted last year have been incorporated into national policy by UNOS and are used by insurance companies to judge whether the costs of evaluation or transplantation will be covered. The guidelines seek to assess a patient's progression of CF by measuring the volume of air that can be expired and the percentage of oxygen and carbon dioxide in their arterial blood. Specific values of these tests are included in the guidelines.
Dr. Keenan and his team conducted a retrospective study to determine if these guidelines were indicative of survival, both on the waiting list and after transplantation. Of the 164 patients with CF seen at the UPMC between 1990 and 1998, 159 were accepted for transplantation and placed on the list; 70 received transplants, 58 at the UPMC; 53 died on the waiting list; and 36 remain on the list.
The average amount of time patients waited until transplantation was 590 days, yet the average time that a patient was on the list before dying was 399 days.
"Among the most significant predictors of death on the waiting list was the percentage of carbon dioxide in the blood, but these were at lower percentages than stipulated in the guidelines," reported Dr. Keenan.
Other significant predictors included the presence of certain infection-causing organisms and the inability of patients to walk 800 feet within six minutes. These parameters, Dr. Keenan noted, are not even included in the guidelines. The test to determine expiration volume, which is included, was not predictive at all, the results reveal.
Further analysis of the 58 patients who received transplants at the UPMC found
not one of the criteria in the international guidelines to be predictive
Contact: Lisa Rossi
University of Pittsburgh Medical Center