Determinants of survival in lung transplantation patients with idiopathic pulmonary fibrosis: a retrospective cohort study

Abstract

Summary Survival after lung transplantation (LTx) for idiopathic pulmonary fibrosis (IPF) is worse compared to other indications for LTx. We investigated the effect of several pretransplant variables including the use of pretransplant corticosteroids (CS) on post‐transplant graft and chronic lung allograft dysfunction (CLAD)‐free survival and functional testing (maximum inspiratory and expiratory pressure, six‐minute walk test, quadriceps and hand pinch force) in a small cohort of IPF patients. We retrospectively compared two groups of IPF patients (n = 36 on CS vs. n = 18 not on CS) who underwent LTx between 2000 and 2016. Analysis of 54 IPF‐LTx patients showed no significant effect on graft survival or functional tests except for maximum inspiratory pressure (P = 0.033) between these two groups (all LTx patients, CS vs. no CS). Regression analysis showed significant impact of procedure with a hazard ratio of 0.423 (CI 95% 0.194, 0.924) favoring sequential single LTx (SSLTx) compared to single lung transplantation (SLTx). When analyzing only the 40 SSLTx patients, corticosteroid‐free patients showed significantly better graft survival compared to patients on CS (P = 0.045) and CLAD‐free survival (P = 0.019). The possible detrimental effect of corticosteroid therapy before LTx was demonstrated in this cohort of SSLTx patients, which questions the use of corticosteroids in a pretransplantation setting.

Idiopathic pulmonary fibrosis: Current and future treatment

“…93 Before transplant, antifibrotic treatment is generally maintained and strict adherence to medication regimen is encouraged, even as clinical trials are being conducted to determine if this affects transplant outcome. 94,95 Lung transplant may be either unilateral or bilateral. Benefits of unilateral transplant are the shorter wait times, easier procedure with lower perioperative complication rate, and the potential to improve the health of two patients from one donor.…”

Regulatory Immune Cells in Idiopathic Pulmonary Fibrosis: Friends or Foes?

“…However, recent analysis of >9.000 patients undergoing lung transplantation for IPF within the United Network of Organ Sharing (UNOS) area demonstrated that double-lung transplantations (DLTs) have improved survival compared to SLTs in patients suffering from IPF (232). Still, five-year survival rates after lung transplantation for IPF are worse compared to other indications (233) with chronic lung allograft dysfunction (CLAD) affecting more than 50% of transplanted lungs after 5 years. Of note, fibrotic processes in the engrafted lung exhibit striking similarities to those in IPF (234).…”

Current status of glucocorticoid usage in solid organ transplantation

“…Pretransplant administration of GCs in patients with idiopathic pulmonary fibrosis may decrease graft survival after lung transplantation compared with GC-free patients[ 127 ]. Although concerns have arisen regarding airway anastomotic complications after lung transplantation in patients who were treated with GCs before transplantation, a retrospective study on 66 double-lung transplant recipients (40 used steroids prior to transplantation) found that early development of airway complications was not significantly higher in patients who took steroids before lung transplantation.…”