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To the Editor: In her Editorial accompanying our article¹ about prognostic factors for lung transplantation among patients with cystic fibrosis (CF), Dr Maurer² noted that we did not comment on the survivorship effect of the rate of change in the FEV₁%.

We, like others,^3-5 initially made the logical assumption that patients with CF who have rapid deterioration of FEV₁% would have an increased risk of death. It has been hypothesized that the subset of patients with the most rapid decline in FEV₁% would gain a survival benefit from lung transplantation. We created theoretical survival models based on this hypothesis that suggested that we might be able to identify appropriate transplantation candidates several years before the optimal moment for transplantation. This would decrease the number of patients who die while on a waiting list, and optimize the use of donated organs. Unfortunately, none of these models are valid . . . [Full Text of this Article]

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