Top Center for Adult Lung Transplants for Cystic Fibrosis in the USA
Based on the available evidence, the University of Pittsburgh appears to be the leading center for adult lung transplants for cystic fibrosis in the United States.
Evidence Supporting This Conclusion
The University of Pittsburgh has demonstrated significant experience and volume in lung transplantation:
- From 1982 to 2009, the University of Pittsburgh performed 1,347 lung and heart-lung transplantations 1
- Cystic fibrosis is listed as one of the four most common indications for lung transplantation at this center 1
- The program has maintained a comprehensive database of all recipients and donors since its inception 1
Program Characteristics
The University of Pittsburgh lung transplant program offers several advantages for CF patients:
- Expanded and flexible recipient criteria, accepting many patients who have been denied transplantation at other major centers 1
- Relatively short median waiting time (37 days in 2009) 1
- Experience with various transplant types including double-lung, single-lung, and heart-lung transplantations 1
- Established protocols for managing complex CF cases 1
Outcomes
The program demonstrates favorable outcomes:
- Overall survival for double-lung transplantation from 2003-2009 was 82.8% at one year and 56.8% at five years 1
- These results compare favorably with international data showing 80% one-year and 56% five-year survival rates 1
Considerations for CF Patients Seeking Transplantation
When considering lung transplantation for CF, patients should be aware that:
- The CF Foundation and European CF Society recommend that all individuals with CF being considered for lung transplantation should be evaluated for non-tuberculous mycobacteria pulmonary disease (NTM-PD) 2
- Current or previous NTM-positive cultures should not preclude consideration for lung transplantation 2
- Criteria to be a transplant candidate vary significantly among transplant programs, highlighting that engagement with more than one transplant program may be necessary 3
- Median survival after transplant for CF has improved to approximately 10 years with significant improvement in quality of life 3
Transplant Timing and Evaluation
- Early discussion regarding transplant as a treatment option and referral to a transplant program are critical to maximizing opportunity 3
- The American Thoracic Society recommends referral for evaluation for patients who are in WHO functional class III or IV on optimized medical therapy or who have rapidly progressive disease 4
- Pulmonary function tests are critical in determining transplant timing 4
While the University of Pittsburgh appears to be the leading center based on available evidence, patients with CF should consider consulting multiple transplant centers to determine the best fit for their specific medical needs and circumstances.