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Theodore G Liou

Publications and source records attributed to Theodore G Liou.

7 recordsLinked to original sources
PubMed2006

Lung transplantation for cystic fibrosis.

PURPOSE OF REVIEW: To examine recent publications on lung transplantation for cystic fibrosis for changes in surgical techniques, selection criteria of patients, and impact on quality of life. RECENT FINDINGS: Recent evidence focuses on cystic fibrosis patient subsets enabling better decisions about listing for lung transplantation as a therapeutic option. There is information about Burkholderia cepacia infection, ventilator dependence, young age, and arthropathy. In the US, the United Network for Organ Sharing has addressed perceived inequities in organ distribution by allocating organs by illness severity rather than time on the waiting list. A Lung Allocation Score ranks severity for patients 12 years of age and older for transplantation based on variables including lung function, oxygen and ventilatory needs, diabetes, weight and physical performance. Some recently studied important variables that influence survival in cystic fibrosis and after lung transplantation, including airway infections, pancreatic exocrine function and acute exacerbations, are not included in the Lung Allocation Score. Few publications have examined quality of life after transplantation, and a definitive work has yet to appear. SUMMARY: New information has refined decision-making about lung transplantation for patients with cystic fibrosis. We examine recent findings and make recommendations for patients, families and medical providers.

Cystic Fibrosis↗
PubMed2005

Use of lung transplantation survival models to refine patient selection in cystic fibrosis.

Lung transplantation in cystic fibrosis may improve survival for patients with low 5-year predicted survival. Identifying characteristics that affect post-transplantation survival may improve patient selection and survival benefit. Using Cystic Fibrosis Foundation Patient Registry and United Network for Organ Sharing data, we identified 845 lung transplant recipients from 1991-2001, and 12,826 control patients from 1997. We used Cox proportional hazards models to identify variables that influence post-transplantation survival. To estimate the survival benefit of transplantation for patients affected by identified variables, we compared Kaplan-Meier survival curves of transplanted and control patients stratified by 5-year predicted survival. Post-transplantation survival improved annually. Youth, Burkholderia cepacia, and cystic fibrosis-related arthropathy increased the post-transplantation hazard of death. Compared with control subjects, transplanted adults with a 5-year predicted survival of less than 50% without B. cepacia or arthropathy have improved survival. Transplanted adults with B. cepacia, arthropathy, or a 5-year predicted survival of greater than 50% have decreased survival. Transplantation never improves survivorship for pediatric patients. Patients with arthropathy, B. cepacia infection, or younger age derive no aggregate survival benefit and must appraise carefully the high risk of decreased post-transplantation survival. Adult patients with low 5-year predicted survival without B. cepacia infection should receive priority for lung transplantation.

Adult↗
PubMed2002

Selection of patients with cystic fibrosis for lung transplantation.

Lung transplantation is the most aggressive therapy available for end-stage lung disease from cystic fibrosis (CF). A new predictive survival model of CF uses demographic, FEV1, nutritional, microbiologic, and acute exacerbation data to produce precise estimates of 5-year survival. The model improves the ability to select patients most likely to have survival benefit from transplantation. We discuss potential application of the survival model to four distinct groups of patients with CF: (1) candidates for cadaveric transplantation, (2) potential living donor recipients, (3) patients infected with multiply-resistant organisms such as Burkholderia cepacia, and (4) patients critically ill and dependent on mechanical ventilation. Measuring the impact of transplantation on quality of life remains a difficult task, and further studies are needed to determine whether lung-transplantation-derived survival benefit implies quality-of-life benefit. However, judicious use of the survival model to select patients for transplantation is likely to improve survival outcomes.

Adolescent↗
PubMed2002

Influenza vaccination coverage level at a cystic fibrosis center.

BACKGROUND: Influenza causes substantial morbidity and mortality, particularly in vulnerable populations. Annual vaccination is the most effective means to prevent or attenuate this illness. The vaccine is recommended for patients with cystic fibrosis (CF) older than 6 months, but the degree of adherence with this recommendation is unknown. OBJECTIVES: To determine 1) the vaccination coverage level for the 1997-1998 influenza season in a population of CF patients, and 2) the factors associated with nonadherence with vaccination. DESIGN: Retrospective chart review, a mailed survey, and telephone interviews. SETTING: Intermountain CF Center. This center, accredited by the CF Foundation, delivers health care to affected individuals throughout the Intermountain West. Care of children and adults is based at Primary Children's Medical Center and the University of Utah Hospital, respectively. The adjacent hospitals are comprehensive, tertiary care medical centers on the University of Utah campus in Salt Lake City. Approximately one third of the center's patient population lives in southern Idaho. There are 2 affiliate centers in Idaho, one based in Pocatello/Idaho Falls and the other in Boise. PATIENTS: All patients over 6 months of age on the center's roster. RESULTS: We found documentation of influenza vaccination status in the medical records of 99 patients; 98 who received the vaccine and 1 who did not because of an allergy to egg products. Through the mailed surveys and telephone interviews, we collected data on 236 additional patients. Thus, we report data on 335 (92.5%) of 362 patients on the center's roster. A total of 256 (76.4%) of 335 patients received the influenza vaccine before the 1997-1998 flu season, including 181 (79.4%) of 228 children (<18 years of age) and 75 (70.1%) of 107 adult patients (</=18 years of age). We also analyzed the data assigning all patients to their major site of care, either the Salt Lake parent center or one of the Idaho affiliates. We found no difference in the vaccination rate when comparing parent center to affiliates: 179 (78.2%) of 229 patients at the parent center were vaccinated versus 77 (72.6%) of 106 patients at the affiliates. For the 79 patients who did not obtain the influenza vaccine, the major reasons were: "forgot," "too healthy," "too busy," "worried about the side effects," or "too sick at the time." The unvaccinated group had fewer clinic visits, fewer CF-related hospitalizations, and lived further from the care center than the vaccinated group. To further explore the association between contact with the center and vaccination status, we categorized patients into those who were evaluated in the outpatient clinic and/or hospitalized in 1997 and those who were not. We found that 80.8% of the 281 patients who actually received care at the center during 1997 were vaccinated as compared with only 59.5% of the 42 patients who did not receive care during that year. The timing of clinic visits also appears to be a critical factor. We found that 87.1% of patients who had a visit during the fourth quarter of the year had the vaccination as compared with 64.9% of patients who did not have a fourth quarter visit. A fourth quarter visit remained highly associated with vaccination in a logistic regression analysis, whereas number of clinic visits did not. CONCLUSIONS: The vaccination coverage level in this vulnerable population is higher than other high-risk groups of comparable age. Nonetheless, there is room for improvement. Strategies aimed at increasing patient contact with the CF center, particularly during the fourth quarter of the calendar year, may result in improved vaccination rates. Additional data encompassing a cross-section of CF centers would be helpful in ensuring that influenza vaccination is receiving adequate attention in this patient population. Systematic monitoring of influenza vaccination rates at a national level should be considered as a means of encouraging compliance with this important preventive measure. cystic fibrosis, influenza, vaccination, health care delivery.

Cystic Fibrosis↗