Lung transplantation for acute exacerbation of interstitial lung disease.
interstitial fibrosis
lung transplantation
Journal
Thorax
ISSN: 1468-3296
Titre abrégé: Thorax
Pays: England
ID NLM: 0417353
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
01
07
2020
accepted:
10
06
2021
pubmed:
7
7
2021
medline:
25
3
2022
entrez:
6
7
2021
Statut:
ppublish
Résumé
Acute exacerbations of interstitial lung diseases (AE-ILD) have a high mortality rate with no effective medical therapies. Lung transplantation is a potentially life-saving option for patients with AE-ILD, but its role is not well established. The aim of this study is to determine if this therapy during AE-ILD significantly affects post-transplant outcomes in comparison to those transplanted with stable disease. We conducted a retrospective study of consecutive patients with AE-ILD admitted to our institution from 2015 to 2018. The comparison group included patients with stable ILD listed for lung transplant during the same period. The primary end-points were in-hospital mortality for patients admitted with AE-ILD and 1-year survival for the transplanted patients. Of 53 patients admitted for AE-ILD, 28 were treated with medical therapy alone and 25 underwent transplantation. All patients with AE-ILD who underwent transplantation survived to hospital discharge, whereas only 43% of the AE-ILD medically treated did. During the same period, 67 patients with stable ILD underwent transplantation. Survival at 1 year for the transplanted patients was not different for the AE-ILD group versus stable ILD group (96% vs 92.5%). The rates of primary graft dysfunction, post-transplant hospital length-of-stay and acute cellular rejection were similar between the groups. Patients with ILD transplanted during AE-ILD had no meaningful difference in overall survival, rate of primary graft dysfunction or acute rejection compared with those transplanted with stable disease. Our results suggest that lung transplantation can be considered as a therapeutic option for selected patients with AE-ILD.
Sections du résumé
BACKGROUND
Acute exacerbations of interstitial lung diseases (AE-ILD) have a high mortality rate with no effective medical therapies. Lung transplantation is a potentially life-saving option for patients with AE-ILD, but its role is not well established. The aim of this study is to determine if this therapy during AE-ILD significantly affects post-transplant outcomes in comparison to those transplanted with stable disease.
METHODS
We conducted a retrospective study of consecutive patients with AE-ILD admitted to our institution from 2015 to 2018. The comparison group included patients with stable ILD listed for lung transplant during the same period. The primary end-points were in-hospital mortality for patients admitted with AE-ILD and 1-year survival for the transplanted patients.
RESULTS
Of 53 patients admitted for AE-ILD, 28 were treated with medical therapy alone and 25 underwent transplantation. All patients with AE-ILD who underwent transplantation survived to hospital discharge, whereas only 43% of the AE-ILD medically treated did. During the same period, 67 patients with stable ILD underwent transplantation. Survival at 1 year for the transplanted patients was not different for the AE-ILD group versus stable ILD group (96% vs 92.5%). The rates of primary graft dysfunction, post-transplant hospital length-of-stay and acute cellular rejection were similar between the groups.
CONCLUSION
Patients with ILD transplanted during AE-ILD had no meaningful difference in overall survival, rate of primary graft dysfunction or acute rejection compared with those transplanted with stable disease. Our results suggest that lung transplantation can be considered as a therapeutic option for selected patients with AE-ILD.
Identifiants
pubmed: 34226204
pii: thoraxjnl-2020-215681
doi: 10.1136/thoraxjnl-2020-215681
pmc: PMC8727643
mid: NIHMS1722865
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
364-369Subventions
Organisme : NIAID NIH HHS
ID : R01 AI135128
Pays : United States
Organisme : NIBIB NIH HHS
ID : U01 EB024501
Pays : United States
Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Eur Respir J. 2011 Feb;37(2):356-63
pubmed: 20595144
Respirology. 2020 Jun;25(6):629-635
pubmed: 31846126
Front Med (Lausanne). 2017 Oct 23;4:176
pubmed: 29109947
Respir Med. 2009 Jun;103(6):846-53
pubmed: 19181509
Ann Thorac Surg. 2014 Dec;98(6):1936-42; discussion 1942-3
pubmed: 25443002
Am J Transplant. 2020 Jan;20 Suppl s1:427-508
pubmed: 31898416
Am J Respir Crit Care Med. 2011 Mar 15;183(6):788-824
pubmed: 21471066
Am J Respir Crit Care Med. 2013 Sep 15;188(6):733-48
pubmed: 24032382
Curr Opin Anaesthesiol. 2020 Feb;33(1):37-42
pubmed: 31714270
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1152-7
pubmed: 25583107
ASAIO J. 2017 Sep/Oct;63(5):551-561
pubmed: 28257296
Chest. 2018 Oct;154(4):818-826
pubmed: 29966665
J Heart Lung Transplant. 2007 Dec;26(12):1229-42
pubmed: 18096473
Am J Respir Crit Care Med. 2016 Aug 1;194(3):265-75
pubmed: 27299520
J Thorac Cardiovasc Surg. 2020 Jul;160(1):320-327.e1
pubmed: 31932054
Am J Respir Crit Care Med. 2013 Mar 1;187(5):527-34
pubmed: 23306540
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2410-5
pubmed: 25444203
J Heart Lung Transplant. 2017 Oct;36(10):1097-1103
pubmed: 28942784
Antonie Van Leeuwenhoek. 1989 Aug;56(2):139-60
pubmed: 2508549
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1510-6
pubmed: 22944092
Eur Respir J. 2015 Oct;46(4):976-87
pubmed: 26160873
Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-e68
pubmed: 30168753
N Engl J Med. 2015 Jun 4;372(23):2185-96
pubmed: 25981908
Chest. 2007 Jul;132(1):214-20
pubmed: 17400667