Background Prior studies have shown that patients with pulmonary fibrosis with mutations in the telomerase genes have a high rate of certain complications after lung transplantation. However, few studies have investigated clinical outcomes by leukocyte telomere length. Methods We conducted an observational cohort study of all pulmonary fibrosis patients who underwent lung transplantation at a single center between January 1, 2007 and December 31, 2014. Leukocyte telomere length was measured from a sample of blood collected prior to lung transplantation and subjects were stratified into two groups (telomere length <10th versus ≥10th percentile). The primary outcome was post-lung transplant survival. Secondary outcomes included incidence of allograft dysfunction, non-pulmonary organ dysfunction and infection. Results Approximately one-third (32%) of subjects had a telomere length below the 10th percentile. Telomere length <10th percentile was independently associated with worse survival (HR 10.9, 95% CI 2.7–44.8, p=0.001). Telomere length <10th percentile was also independently associated with a shorter time to the onset of chronic lung allograft dysfunction (CLAD) (HR 6.3, 95% CI 2.0–20.0, p=0.002). Grade 3 primary graft dysfunction occurred more frequently in the <10th percentile group compared to the ≥10th percentile group (28% vs 7%, p=0.034). There was no difference in the incidence of acute cellular rejection, cytopenias, infection or renal dysfunction in the two groups. Conclusions Telomere length <10th percentile was associated with worse survival and shorter time to onset of CLAD, and thus represents a biomarker that may aid in the risk stratification of pulmonary fibrosis patients prior to lung transplantation.

Background There is limited knowledge about adenoma detection rates (ADRs) in patients with a positive fecal immunochemical test (FIT). We hypothesized that colonoscopy performed after FIT would result in higher ADRs. Methods We reviewed ADRs for colonoscopies performed after a positive FIT test and compared them to ADR rates for routine colonoscopy performed without an initial FIT test between November 2014 and March 2017 at multiple endoscopy sites. Results A total of 979 patients underwent a FIT testing in the Texas panhandle, of whom 12.1% (n=119) tested positive. Also, 32.8% (n=39) were found to have one or more tubular adenomatous polyps on final pathological examination. Among these patients, the majority were female (64.1%; n=25). Of the patients, 15.9% (n=19) had a hyperplastic polyp, 1.7% (n=2) had findings consistent with ulcerative colitis, and 0.8% (n=1) were positive for an adenocarcinoma. In the control group of 2,603 patients in whom routine colonoscopy was performed as the initial tool for screening, 719 were found to have one or more tubular adenomas, with an ADR rate of 27.5%. In this group, the cancer rate was found to be 1%. Conclusions There was a significant increase in the ADR when colonoscopy is conducted after a positive FIT test. Recommending colonoscopies after a positive FIT test will not only improve ADRs significantly but also lower the overall healthcare cost for screening colon cancer in this era of escalating healthcare costs.

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