RT Journal Article
SR Electronic
T1 Lung transplantation for interstitial lung disease: evolution over three decades
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e001387
DO 10.1136/bmjresp-2022-001387
VO 10
IS 1
A1 Swee W Leong
A1 Saskia Bos
A1 James L Lordan
A1 Arun Nair
A1 Andrew J Fisher
A1 Gerard Meachery
YR 2023
UL http://bmjopenrespres.bmj.com/content/10/1/e001387.abstract
AB Background Interstitial lung disease (ILD) has emerged as the most common indication for lung transplantation globally. However, post-transplant survival varies depending on the underlying disease phenotype and comorbidities. This study aimed to describe the demographics, disease classification, outcomes and factors associated with post-transplant survival in a large single-centre cohort.Methods Data were retrospectively assessed for 284 recipients who underwent lung transplantation for ILD in our centre between 1987 and 2020. Patient characteristics and outcomes were stratified by three eras: 1987–2000, 2001–2010 and 2011–2020.Results Median patients’ age at time of transplantation was significantly higher in the most recent decade (56 (51–61) years, p<0.0001). Recipients aged over 50 years had worse overall survival compared with younger patients (adjusted HR, aHR 2.36, 95% CI 1.55 to 3.72, p=0.0001). Better survival was seen with bilateral versus single lung transplantation in patients younger than 50 years (log-rank p=0.0195). However, this survival benefit was no longer present in patients aged over 50 years. Reduced survival was observed in fibrotic non-specific interstitial pneumonia compared with idiopathic pulmonary fibrosis, which remained the most common indication throughout (aHR 2.61, 95% CI 1.40 to 4.60, p=0.0015).Conclusion In patients transplanted for end-stage ILD, older age and fibrotic non-specific interstitial pneumonia were associated with poorer post-transplant survival. The benefit of bilateral over single lung transplantation diminished with increasing age, suggesting that single lung transplantation might still be a feasible option in older candidates.The data that support the findings of this study are available from the corresponding author upon reasonable request and are not publicly available.