An Intention-to-treat View of Lung Transplantation for Interstitial Lung Disease: Successful Strategies to Minimize Waiting List and Posttransplant Mortality

Zhu, Michael Z.L.; Levvey, B.; McGiffin, David C.; Snell, Gregory I

doi:10.1097/tp.0000000000003664

Cited by 9 publications

(12 citation statements)

References 36 publications

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“…Such distributional shifts in population capped the upper bounds in predictive accuracy of these variables. On the other hand, the higher donor lung availability [ 21 , 37 ] potentially allowed less severe CF patients in Canada to receive LTx, which resulted in the lower relevance between LTx and these markers of severe lung diseases. For instance, the risk factor of hospital stay got closer to the dashed line when only the single endpoint of death was considered in Fig 2(b) , which indicated nearly equal predictive power in the two populations compared to Fig 2(a) .…”

Section: Resultsmentioning

confidence: 99%

External validity of machine learning-based prognostic scores for cystic fibrosis: A retrospective study using the UK and Canadian registries

Qin

Alaa²,

Floto³

et al. 2023

PLOS Digit Health

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Precise and timely referral for lung transplantation is critical for the survival of cystic fibrosis patients with terminal illness. While machine learning (ML) models have been shown to achieve significant improvement in prognostic accuracy over current referral guidelines, the external validity of these models and their resulting referral policies has not been fully investigated. Here, we studied the external validity of machine learning-based prognostic models using annual follow-up data from the UK and Canadian Cystic Fibrosis Registries. Using a state-of-the-art automated ML framework, we derived a model for predicting poor clinical outcomes in patients enrolled in the UK registry, and conducted external validation of the derived model using the Canadian Cystic Fibrosis Registry. In particular, we studied the effect of (1) natural variations in patient characteristics across populations and (2) differences in clinical practice on the external validity of ML-based prognostic scores. Overall, decrease in prognostic accuracy on the external validation set (AUCROC: 0.88, 95% CI 0.88-0.88) was observed compared to the internal validation accuracy (AUCROC: 0.91, 95% CI 0.90-0.92). Based on our ML model, analysis on feature contributions and risk strata revealed that, while external validation of ML models exhibited high precision on average, both factors (1) and (2) can undermine the external validity of ML models in patient subgroups with moderate risk for poor outcomes. A significant boost in prognostic power (F1 score) from 0.33 (95% CI 0.31-0.35) to 0.45 (95% CI 0.45-0.45) was observed in external validation when variations in these subgroups were accounted in our model. Our study highlighted the significance of external validation of ML models for cystic fibrosis prognostication. The uncovered insights on key risk factors and patient subgroups can be used to guide the cross-population adaptation of ML-based models and inspire new research on applying transfer learning methods for fine-tuning ML models to cope with regional variations in clinical care.

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Section: Resultsmentioning

confidence: 99%

External validity of machine learning-based prognostic scores for cystic fibrosis: A retrospective study using the UK and Canadian registries

Qin

Alaa²,

Floto³

et al. 2023

PLOS Digit Health

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“…The LTx group from Melbourne [ 8 ] compared the early- and mid-term outcomes of 31 IPF patients, in whom antifibrotics were continued until the day of LTx, to 71 IPF patients not on antifibrotics before LTx. The authors reported no bronchial anastomotic complications in either group and no difference in rates of reoperation for wound or bleeding complications [antifibrotic: 13% (4/31), control: 8.4% (6/71); P = 0.49].…”

Section: Resultsmentioning

confidence: 99%

Does continuation of antifibrotics before lung transplantation influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis?

Zhu

Huang

Liu

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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Summary A best evidence topic was written according to a structured protocol. The question addressed was: ‘Does continuation of antifibrotics before lung transplantation (LTx) influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis (IPF) with regard to mortality, bronchial anastomotic dehiscence, reoperation for bleeding and wound complications, primary graft dysfunction or longer-term survival and allograft rejection?’ A total of 261 articles were found using the reported search strategy, of which 7 represented the best evidence to answer the clinical question. Six out of 7 studies demonstrated equivalent post-transplant survival among IPF patients on antifibrotics before LTx compared with controls. Five out of 6 studies showed no increase in the risk of major bleeding, wound or bronchial anastomotic complications. One bi-institutional study found a higher incidence of early bronchial anastomotic dehiscence, but this difference was not statistically significant after longer term follow-up. In a study that only included IPF patients who underwent single LTx, a lower incidence of grade 3 primary graft dysfunction was reported in the antifibrotic group compared with controls. Overall, to date, only small (N < 40 in the antifibrotic group), non-risk-adjusted, retrospective observational studies have been published. Notwithstanding, the summation of available evidence suggests that, in IPF patients, continuation of antifibrotic therapy before LTx is likely safe, and the rates of perioperative bleeding, wound or bronchial anastomotic complications, as well as 30-day and 1-year survival, are similar to patients not on antifibrotics before LTx.

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“…27,51,52 Five studies examined the relationship of the 6MWT with QOL, 46,[54][55][56][57] with 3 studies showing some relationship with QOL pretransplant. 46,55,56 One study 26 examined and showed a relationship between the 6MWT and delisting of transplant candidates. More information about the direction of these relationships is presented in Table S1 (SDC, http://links.lww.…”

Section: Relationship With Clinical Outcomes In Lung Transplant Candi...mentioning

confidence: 99%

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review

Bourgeois

Shallwani

Al-Huda

et al. 2022

Transplantation Direct

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Background. Measures of exercise capacity, frailty, and physical function are commonly used in lung transplant candidates and recipients to evaluate their physical limitations and the effects of exercise training and to select candidates for transplantation. It is unclear how these measures are related to clinical outcomes and healthcare utilization before and after lung transplantation. The purpose of this scoping review was to describe how measures of exercise capacity, physical function, and frailty are related to pre- and posttransplant outcomes. Methods. We considered studies of any design that included performance-based tests of exercise capacity, physical function, and frailty in adult lung transplant candidates or recipients. Outcomes of interest were clinical outcomes (eg, mortality, quality of life) and healthcare utilization. Results. Seventy-two articles met the inclusion criteria. The 6-min walk test (6MWT) was shown to be related to mortality on the waiting list with different distance values as cutoffs points. There were inconsistent results regarding the relationship of the 6MWT with other clinical outcomes. Few studies have examined the relationship between the cardiopulmonary exercise test or the short physical performance battery and clinical outcomes, although some studies have shown relationship with survival posttransplant and quality of life. Few studies examined the relationship between the tests of interest and healthcare utilization‚ and the results were inconsistent. Conclusions. Except for the relationship between the 6MWT and mortality on the waiting list, there is limited evidence regarding the relationship of performance-based measures of exercise capacity, frailty, and physical function with clinical outcomes or healthcare utilization.

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An Intention-to-treat View of Lung Transplantation for Interstitial Lung Disease: Successful Strategies to Minimize Waiting List and Posttransplant Mortality

Cited by 9 publications

References 36 publications

External validity of machine learning-based prognostic scores for cystic fibrosis: A retrospective study using the UK and Canadian registries

External validity of machine learning-based prognostic scores for cystic fibrosis: A retrospective study using the UK and Canadian registries

Does continuation of antifibrotics before lung transplantation influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis?

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review

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