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Cited by 9Transplantation: Methods and OutcomesCystic Fibrosis Research AdvancesOrgan Transplantation Techniques and Outcomes

Cystic fibrosis survival outcomes following second lung transplant: The north American experience

Open access
Alshehri, Moayad, Ramos, Kathleen J., Sykes, Jenna, Ma, Xiayi, Stanojevic, Sanja, Quon, Bradley S., Marshall, Bruce C., Cromwell, Elizabeth +7 more·2023·Clinical Transplantation
DOI 10.1111/ctr.15097PMC PMC10840857
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Abstract

Introduction Re‐transplant is an option for those who develop end‐stage lung disease due to rejection; however, little data exist following re‐transplantation in cystic fibrosis (CF). Methods Data from the Canadian CF Registry and US CF Foundation Patient Registry supplemented with data from United Network for Organ Sharing were used. Individuals who underwent a 2nd lung transplant between 2005 and 2019 were included. The Kaplan‐Meier method was used to estimate the probability of survival post‐second transplant at 1, 3, and 5-years. Results Of those people who were waitlisted for a second transplant (N = 818), a total of 254 (31%) died waiting, 395 (48%) were transplanted and 169 (21%) people were alive on the waitlist. Median survival time after 2nd lung transplant was 3.3 years (95% CI: 2.8‐4.1). The 1‐, 3‐ and 5-year survival rates were 77.4% (95% CI: 73.1‐82%), 52% (95% CI: 46.7‐58%) and 39.4% (95% CI: 34.1‐45.6%). Conclusions Survival following second lung transplant in CF patients is lower than estimates following the first transplant. Over half of subjects who are potentially eligible for a second transplant die without receiving a second organ. This warrants further investigation.

Integrity signals

Registry

Crossref · 10.1111/ctr.15097

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

11 of 22 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Interpretationown data

    Survival following a second lung transplant in cystic fibrosis patients is lower than estimates following a first transplant.

    “Survival following second lung transplant in CF patients is lower than estimates following first transplant.”
    • Also stated in: § DISCUSSION · boosted
      “Our results confirm lower survival after re-transplant at each of these time points.”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [9] 9. Rucker AJ, Nellis JR, Klapper JA, Hartwig MG. Lung retransplantation in the modern era. J Thorac Dis. 2021;13(11):6587-6593. [PubMed: 34992837] source

      The Patient selection section reports lower 1-, 3-, and 5-year survival after lung retransplantation than after a first transplant in an overall transplant population. It does not give that comparison specifically for patients with cystic fibrosis, and it notes that survival differences were minimal after adjustment for comorbidities. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [17] 17. Stephenson AL, Sykes J, Berthiaume Y, et al. Clinical and demographic factors associated with post-lung transplantation survival in individuals with cystic fibrosis. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2015;34(9):1139-1145. [PubMed: 26087666] source
    • cites [18] 18. Kawut SM, Lederer DJ, Keshavjee S, et al. Outcomes after lung retransplantation in the modern era. American journal of respiratory and critical care medicine. 2008;177(1):114-120. [PubMed: 17901410] source
    • cites [4] 4. Stephenson AL, Ramos KJ, Sykes J, et al. Bridging the survival gap in cystic fibrosis: An investigation of lung transplant outcomes in Canada and the United States. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2021;40(3):201-209. [PubMed: 33386232] source

      The Methods (page unavailable) say survival was measured from the first lung transplant and that a sensitivity analysis censored patients at repeat transplant. The Results (page unavailable) refer to that analysis but do not report survival following a second transplant or compare it with survival following a first. Searches for second and repeat transplant survival found no such comparison in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Findingown data

    Median survival after a second lung transplant in cystic fibrosis was 3.3 years (95% CI 2.8-4.1).

    “Median survival time after 2 nd lung transplant was 3.3 years (95% CI 2.8-4.1).”
    • Also stated in: § Post-transplant survival: 2005-2019 · plain
      “Median survival following re-transplantation was 3.3 years (95% confidence interval (CI) 2.8-4.1)(Figure 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Between 2005 and 2019, 395 out of 1226 (32.2%) potentially eligible individuals with cystic fibrosis underwent a second lung transplant.

    “Between 2005 and 2019, there were 395 out of 1226 (32.2%) individuals with CF who underwent second lung transplant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was insufficient evidence to suggest a difference in survival after second lung transplant between Canada and the United States.

    “There was insufficient evidence to suggest that there is a difference in survival between the two countries.”
    Quote in the paperSubstantial claim
  • Findingown data

    The 1-, 3-, and 5-year survival probabilities were similar comparing early versus late re-transplantation.

    “The 1-, 3-, and 5-year survival probabilities were similar comparing early versus late retransplantation (Figure 3).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 19
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Osho et al. found worse survival in those who underwent re-transplant within 90 days of the initial transplant.

    “Osho et al. found worse survival in those who underwent re-transplant within 90 days of the initial transplant.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] 19. Osho AA, Castleberry AW, Snyder LD, et al. Differential outcomes with early and late repeat transplantation in the era of the lung allocation score. Ann Thorac Surg. 2014;98(6):1914-1920; discussion 1920-1911. [PubMed: 25442999] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous literature has suggested that early re-transplant recipients have worse outcomes than those requiring a re-transplant farther out from the initial transplant.

    “Previous literature has suggested that early re-transplant recipients have worse outcomes than those requiring a re-transplant farther out from the initial transplant.19”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] 19. Osho AA, Castleberry AW, Snyder LD, et al. Differential outcomes with early and late repeat transplantation in the era of the lung allocation score. Ann Thorac Surg. 2014;98(6):1914-1920; discussion 1920-1911. [PubMed: 25442999] source

  • May combine two claims.

    Premisecitation

    Previous published literature reported 1-, 3-, and 5-year survival rates after first lung transplantation for CF of 88.3%, 71.8%, and 60.3% in the US and 90.5%, 79.9%, and 69.7% in Canada.

    “Previous published literature reported the 1-, 3-and 5-year survival rates were 88.3%, 71.8% and 60.3% in the US and 90.5%, 79.9% and 69.7% in Canada for individuals who underwent a first lung transplantation for CF. 4”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] 4. Stephenson AL, Ramos KJ, Sykes J, et al. Bridging the survival gap in cystic fibrosis: An investigation of lung transplant outcomes in Canada and the United States. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2021;40(3):201-209. [PubMed: 33386232] source

  • May combine two claims.

    Premisecitation

    The CF population may differ from the non-CF population given their young age, the impact of persistent CFTR dysfunction in other key organs like gut and liver, and their increased risk of complications such as CF-related diabetes and renal dysfunction from chronic aminoglycoside use.

    “The CF population may differ from the non-CF population given their young age, the impact of persistent CF transmembrane conductance regulatory (CFTR) dysfunction in other key organs like gut and liver, and their increased risk of complications such as CF-related diabetes and renal dysfunction from chronic aminoglycoside use.10,11”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [10] 10. Quon BS, Mayer-Hamblett N, Aitken ML, Goss CH. Risk of post-lung transplant renal dysfunction in adults with cystic fibrosis. Chest. 2012;142(1):185-191. [PubMed: 22222189] source

      The Discussion describes CF lung transplant recipients as younger than recipients with other diagnoses and identifies CF-related diabetes as a risk factor for posttransplant renal dysfunction. It also suggests that lifetime IV aminoglycoside exposure may contribute to renal risk, but says exposure was not directly assessed. The paper does not address persistent CFTR dysfunction in the gut or liver. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [11] 11. Quon BS, Mayer-Hamblett N, Aitken ML, Smyth AR, Goss CH. Risk factors for chronic kidney disease in adults with cystic fibrosis. American journal of respiratory and critical care medicine. 2011;184(10):1147-1152. [PubMed: 21799076] source

      The Abstract identifies CF-related diabetes and lifetime nephrotoxic drug exposure as potential kidney-disease risk factors in adults with CF. The Discussion says IV aminoglycosides are nephrotoxic, but this study did not establish an association between its proxy for cumulative exposure and chronic kidney disease. The cited paper does not address the claimed effects of CFTR dysfunction in the gut and liver or establish the comparison with the non-CF population based on young age. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Pre-transplant factors known to be associated with mortality following first lung transplant include B. cepacia complex, year of transplant, and CFTR functional class, while male sex and age at transplant were of borderline significance.

    “Pre-transplant factors known to be associated with mortality following first lung transplant include B. cepacia complex, year of transplant, and CFTR functional class while male sex and age at transplant were of borderline significance.7,8”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] 7. Koutsokera A, Varughese RA, Sykes J, et al. Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: A systematic review and meta-analysis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2019;18(3):407-415. [PubMed: 30482682] source
    • cites [8] 8. Clausen ES, Weber JM, Ramos KJ, Snyder LD. Survival difference between high-risk and low-risk CFTR genotypes after lung transplant. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2022. source

      The Results (Graft Failure Analysis; page not provided) associate CFTR genotype classification and a history of Burkholderia cepacia complex with graft failure, defined as death or retransplant. They do not identify transplant year or male sex as associated factors. Nor do they describe age at transplant as borderline significant: age was significantly associated with graft failure at 35 years or younger, but not above 35. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Clausen et al. found that individuals with high-risk genotypes (functional class I-III) had worse survival following first lung transplant compared to those with at least one Class IV or V mutation.

    “When looking at survival by genotype, Clausen et al. recently published a study showing that individuals with high-risk genotypes (categorized by functional class I-III) had worse survival following first lung transplant compared to those with at least one Class IV or V mutation.8”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] 8. Clausen ES, Weber JM, Ramos KJ, Snyder LD. Survival difference between high-risk and low-risk CFTR genotypes after lung transplant. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2022. source

  • May combine two claims.

    Premisecitation

    Although risk factors for worse survival following re-transplant have been identified, the results are often reported overall and not by underlying disease state, which limits understanding of how CF-specific factors influence mortality in this population.

    “Although risk factors for worse survival following re-transplant have been identified, the results are often reported overall and not by underlying disease state which limits our understanding of how CF-specific factors influence mortality in this population.9”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] 9. Rucker AJ, Nellis JR, Klapper JA, Hartwig MG. Lung retransplantation in the modern era. J Thorac Dis. 2021;13(11):6587-6593. [PubMed: 34992837] source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Interpretationown data

    Our findings were consistent with the results of Clausen et al. following re-transplant.

    “Our findings were consistent with these results following re-transplant.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] 8. Clausen ES, Weber JM, Ramos KJ, Snyder LD. Survival difference between high-risk and low-risk CFTR genotypes after lung transplant. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2022. source

      The Discussion reports better graft survival for recipients with low-risk than high-risk CFTR genotypes. However, the Methods (Study cohort) specify that the study included patients undergoing their first lung transplant; it does not report survival following re-transplant. The Results (Graft Failure Analysis) count re-transplant as part of a graft-failure outcome, not as the starting point for a survival analysis. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    A total of 662 out of 1226 (54.0%) potentially eligible individuals with cystic fibrosis died without a second lung transplant.

    “A total of 662/1226 (54.0%) individuals died without a second lung transplant.”
    • Also stated in: § Abstract · plain
      “Over half of subjects who are potentially eligible for a second transplant die without receiving a second organ.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of 818 people waitlisted for a second transplant, 254 (31%) died waiting, 395 (48.3%) were transplanted, and 169 (21%) were alive on the waitlist.

    “Of those people who were waitlisted for a second transplant (N=818), a total of 254 (31%) died waiting, 395 (48%) were transplanted and 169 (21%) people were alive on the waitlist.”
    • Also stated in: § RESULTS · plain
      “Of those people who were listed for a second transplant (N=818), a total of 254 (31%) died waiting during the study period, 395 (48.3%) were ultimately transplanted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority (95%) of re-transplants were in adults over the age of 18 years.

    “The majority (95%) of re-transplants were in adults over the age of 18 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 1-, 3-, and 5-year survival rates after a second lung transplant in cystic fibrosis were 77.4% (95% CI 73.1-82%), 52% (95% CI 46.7-58%), and 39.4% (95% CI 34.1-45.6%).

    “The 1-, 3-and 5-year survival rates were 77.4% (95% CI 73.1-82%), 52% (95% CI 46.7-58%) and 39.4% (95% CI 34.1-45.6%).”
    • Also stated in: § Post-transplant survival: 2005-2019 · plain
      “The 1-, 3-and 5-year survival rates were 77.4% (95% CI 73.1-82%), 52% (95% CI 46.7-58%) and 39.4% (95% CI 34.1-45.6%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Higher lung transplant center volume was associated with lower mortality although this was not statistically significant (HR 0.997, 95% CI 0.99-1.0; p=0.07).

    “Higher lung transplant center volume was associated with lower mortality although this was not statistically significant (HR 0.997, 95% CI 0.99-1.0;p=0.07).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Median age at re-transplant was 30.1 years (interquartile range 23.9-37.3).

    “Median age at re-transplant was 30.1 years (interquartile range (IQR) 23.9-37.3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Only 14 individuals were re-transplanted within 90 days of the initial transplant, making it difficult to make a direct comparison to prior published literature.

    “Furthermore, in our study only 14 individuals were re-transplanted within 90 days of the initial transplant making is difficult to make a direct comparison to prior published literature.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    When dichotomizing transplant center volume, the cut off of 26 was chosen based on the literature; however, dichotomizing a continuous variable may correspond with a loss in statistical power, so the results when transplant center volume is categorized should be interpreted with caution.

    “When dichotomizing transplant center volume, we chose to use the cut off of 26 based on the literature.However, we recognize that dichotomizing a continuous variable may correspond with a loss in statistical power and therefore, the results when transplant center volume is categorized should be interpreted with caution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of chronic lung allograft dysfunction is approximately 50% five years post-lung transplant.

    “The incidence of CLAD is approximately 50% five-years post-lung transplant.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Bos S, Vos R, Van Raemdonck DE, Verleden GM. Survival in adult lung transplantation: where are we in 2020? Curr Opin Organ Transplant. 2020;25(3):268-273. [PubMed: 32332197] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kawut et al. found that early re-transplant within 30 days of the first transplant was associated with significantly higher mortality (HR 2.6, 95% CI 1.4-4.9, p=0.003).

    “Kawut et al. found that early re-transplant within 30 days of the first transplant was associated with significantly higher mortality (HR 2.6, 95% CI 1.4-4.9,p=0.003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Kawut SM, Lederer DJ, Keshavjee S, et al. Outcomes after lung retransplantation in the modern era. American journal of respiratory and critical care medicine. 2008;177(1):114-120. [PubMed: 17901410] source

  • May combine two claims.

    Study design and conductown data

    The study did not have complete data on clinical parameters after the initial transplant on all patients, which limited the ability to examine the impact of these factors on survival.

    “We did not have complete data specifically on clinical parameters (for example lung function, nutritional markers, healthcare utilization etc) after the initial transplant on all patients which limited our ability to examine the impact of these factors on survival.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The sample size of early re-transplants was small and may have been underpowered to detect a significant difference.

    “Furthermore, our sample size of early re-transplants was small and may have been underpowered to detect a significant difference.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    It is difficult to compare our results to the published literature as prior papers typically include all-comers and were not specific to individuals with CF.

    “It is difficult to compare our results to the published literature as prior papers typically include all-comers and were not specific to individuals with CF.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Kawut et al. showed that although survival rates post lung re-transplant have improved in the modern era, re-transplant still carries an increased risk compared to the initial transplant.

    “Kawut et al. showed that although survival rates post lung re-transplant have improved in the modern era, re-transplant still carries with it an increased risk compared to the initial transplant.18”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Kawut SM, Lederer DJ, Keshavjee S, et al. Outcomes after lung retransplantation in the modern era. American journal of respiratory and critical care medicine. 2008;177(1):114-120. [PubMed: 17901410] source

  • May combine two claims.

    Study design and conductown data

    The study used population-based longitudinal data captured within both US CFFPR and OPTN registries with low rates of loss to follow up, allowing for the largest CF sample of re-transplants to date.

    “The strengths of our study include population-based longitudinal data captured within both US CFFPR and OPTN registries in the US with low rates of loss to follow up allowing for the largest CF sample of re-transplants to date.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Chan et al. stated that the second lung transplant cohort experienced re-intubation more frequently, required longer ventilatory support, and were in hospital longer than those who had a first lung transplant.

    “Further, the authors stated that the second lung transplant cohort experienced re-intubation more frequently, required longer ventilatory support and were in hospital longer than those who had a first lung transplant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] 12. Chan EG, Hyzny EJ, Ryan JP, Morrell MR, Pilewski J, Sanchez PG. Outcomes following lung re-transplantation in patients with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2022;21(3):482-488. [PubMed: 34949557] source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    It is possible that a portion of individuals who died without a second transplant may have benefited from a second lung transplant but instead were not given the opportunity.

    “However, we suggest that it is possible a portion of these individuals may have benefited from a second lung transplant but instead were not given the opportunity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Individuals who undergo a second lung transplantation are a highly selected group deemed to have the best chance of success following the second transplant, which limits the generalizability of the findings to the entirety of the CF lung transplant population.

    “Individuals who undergo a second lung transplantation are a highly selected group of individuals deemed to have the best chance of success following the second transplant which limits the generalizability of our findings to the entirety of the CF lung transplant population.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    By focusing on those who received a second transplant, the study ignores those individuals who may have been potentially eligible for re-transplant but who did not have the opportunity.

    “By focusing on those who received a second transplant, this ignores those individuals who may have been potentially eligible for re-transplant but who did not have the opportunity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Chan et al. found that CF patients experienced significant clinical decline in renal, cardiac, and pulmonary function at the time of lung re-transplantation.

    “These authors also found that CF patients experienced significant clinical decline in renal, cardiac, and pulmonary function at the time of lung re-transplantation.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] 12. Chan EG, Hyzny EJ, Ryan JP, Morrell MR, Pilewski J, Sanchez PG. Outcomes following lung re-transplantation in patients with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2022;21(3):482-488. [PubMed: 34949557] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The definition of those potentially eligible for re-transplant used in the study was broad and likely underestimates the true prevalence of re-transplant in the truly eligible CF population.

    “The definition of those potentially eligible for re-transplant used in our study was broad and likely underestimates the true prevalence of re-transplant in the truly eligible CF population given we did not have granular data on eligibility for a second transplant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The CCFR lacked markers of low socioeconomic status for CF recipients in Canada, therefore the study did not examine the relationship between socioeconomic status and health outcomes as a potential barrier to re-transplantation.

    “Finally, the CCFR lacked markers of low socioeconomic status (SES) for CF recipients in Canada, therefore we did not examine the relationship between SES and health outcomes as a potential barrier to re-transplantation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A recent study by Chan et al. utilized UNOS data to examine factors associated with outcomes following second lung transplant specifically in individuals with CF (n=277) and found that only mechanical ventilatory support as a bridge to re-transplant was significantly associated with graft failure at 3 years.

    “A recent study by Chan et al. utilized United Network for Organ Sharing (UNOS) data to examine factors associated with outcomes following second lung transplant specifically in individuals with CF (n=277) and found that only mechanical ventilatory support as a bridge to re-transplant was significantly associated with graft failure at 3 years.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] 12. Chan EG, Hyzny EJ, Ryan JP, Morrell MR, Pilewski J, Sanchez PG. Outcomes following lung re-transplantation in patients with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2022;21(3):482-488. [PubMed: 34949557] source

  • May combine two claims.

    Study design and conductreasoning

    The conducted linkage to OPTN resulted in more accurate capture of key data such as transplant and vital status, while the inclusion of CF Registry data allowed for examination of CF-specific baseline characteristics.

    “The conducted linkage to OPTN resulted in more accurate capture of key data such as transplant and vital status while the inclusion of CF Registry data allowed for examination of CF-specific baseline characteristics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The 5-year survival for the re-transplant group in Chan et al. was 47.9% compared to 39.4% in the current analysis.

    “Interestingly, Chan et al. reported the 5-year survival for the re-transplant group was 47.9% compared to 39.4% in our current analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chan et al.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

33 of 33

  • The authors state this as an assumption.

    If a person died of non-cardiopulmonary causes without a second transplant, they had other organ dysfunction that would make them ineligible for a second lung transplant.

    “we excluded those individuals who died without a second transplant if they died of non-cardiopulmonary causes under the assumption that if they had other organ dysfunction, this would make them ineligible for a 2 nd lung transplant (N=1163).”

  • The authors state this as an assumption.

    If a person died of cardiorespiratory causes without evidence of graft organ dysfunction, the death was due to something other than CLAD and they would not be a candidate for a second lung transplant.

    “If someone died of cardiorespiratory causes without evidence of graft organ dysfunction (based on the variable GRF_STAT) in the UNOS data set, these individuals were also excluded from the eligible re-transplant pool under the assumption that the cardiorespiratory death was due to something other than CLAD (for example, myocardial infarction etc.) and thus they would not be a candidate for a 2 nd”

  • The paper relies on this without support.

    Individuals who remained alive without listing for re-transplant did not have progressive lung disease that would warrant a re-transplant.

    “Finally, we excluded anyone who remained alive without listing for re-transplant as we have no data to suggest they had progressive lung disease that would warrant a re-transplant (N=2565).”

  • The paper relies on this without support.

    Elexacaftor/tezacaftor/ivacaftor is not indicated post-transplant because the lungs no longer have cystic fibrosis.

    “Currently, ETI in not indicated post-transplant as the lungs no longer have CF thus there will be a relative increase in the number of re-transplants relative to primary lung transplantation moving forward.”

  • The paper relies on this without support.

    Re-transplantation is surgically more complex than the initial transplant.

    “Re-transplantation is surgically more complex than the initial transplant and our data show that undergoing re-transplant at a high-volume transplant center may decrease the risk of mortality after re-transplantation.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CFRD percentage does not match the stated re-transplant cohort size

    Minor

    The table lists 269 recipients with CFRD out of 395 re-transplant recipients, which is 68.1%, not 90.3%. No different denominator is stated for this row.

    Reported 90.3 · recomputed 68.101266

  • Third-transplant censoring is said both to have no effect and to explain lower survival

    Minor

    The results say censoring at the third transplant left the reported survival estimates unchanged. The discussion then proposes not censoring at that point as a reason this analysis produced a lower survival estimate.

2 of 2

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Authors
Alshehri, M., Ramos, K. J., Sykes, J., Ma, X., Stanojevic, S., Quon, B. S., Marshall, B. C., Cromwell, E., Ostrenga, J. S., Faro, A., Elbert, A., Todd, J., Chaparro, C., Goss, C. H., & Stephenson, A. L.
Affiliations
  • St. Michael's Hospital (CA)
  • University of Washington Medical Center (US)
  • Dalhousie University (CA)
  • University of British Columbia (CA)
  • Cystic Fibrosis Foundation (US)
  • University Health Network (CA)
Corresponding author
Stephenson, Anne L.
ORCID
Venue
Clinical Transplantation
Publisher
Wiley
Published
2023-08-10
Volume
37
Issue
11
Pages
e15097-e15097
ISSN
  • 0902-0063 (ISSN-L)
  • 1399-0012
DOI
10.1111/ctr.15097
PMC
PMC10840857
OpenAlex
W4385751772
Cited by
9
References
22
Citations by year
2026: 1 · 2025: 2 · 2024: 5 · 2023: 1
FWCI
2.40
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Transplantation (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Cystic Fibrosis Foundation Therapeutics
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Keywords
cystic fibrosis, retransplantation, post-transplant survival, lung rejection, end-stage lung disease
MeSH terms
Canada, Cystic Fibrosis, Humans, Lung, Proportional Hazards Models, Lung Transplantation

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