Lung transplantation for interstitial lung disease: evolution over three decades
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, out...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/10/1/e001387.full |
| _version_ | 1797371379253772288 |
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| author | Gerard Meachery Andrew J Fisher James L Lordan Arun Nair Swee W Leong Saskia Bos |
| author_facet | Gerard Meachery Andrew J Fisher James L Lordan Arun Nair Swee W Leong Saskia Bos |
| author_sort | Gerard Meachery |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T18:18:02Z |
| format | Article |
| id | doaj.art-d47d98e8d6ba44b0b48ada509140d051 |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-08T18:18:02Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-d47d98e8d6ba44b0b48ada509140d0512023-12-31T07:20:07ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392023-11-0110110.1136/bmjresp-2022-001387Lung transplantation for interstitial lung disease: evolution over three decadesGerard Meachery0Andrew J Fisher1James L Lordan2Arun Nair3Swee W Leong4Saskia Bos52 Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK1 Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UKInstitute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKInstitute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UKInstitute of Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK1 Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UKBackground 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.https://bmjopenrespres.bmj.com/content/10/1/e001387.full |
| spellingShingle | Gerard Meachery Andrew J Fisher James L Lordan Arun Nair Swee W Leong Saskia Bos Lung transplantation for interstitial lung disease: evolution over three decades BMJ Open Respiratory Research |
| title | Lung transplantation for interstitial lung disease: evolution over three decades |
| title_full | Lung transplantation for interstitial lung disease: evolution over three decades |
| title_fullStr | Lung transplantation for interstitial lung disease: evolution over three decades |
| title_full_unstemmed | Lung transplantation for interstitial lung disease: evolution over three decades |
| title_short | Lung transplantation for interstitial lung disease: evolution over three decades |
| title_sort | lung transplantation for interstitial lung disease evolution over three decades |
| url | https://bmjopenrespres.bmj.com/content/10/1/e001387.full |
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