Short-term outcomes of lung transplant in idiopathic pulmonary fibrosis

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is currently the main indication for lung transplant (LTx) in the United States. Opinions differ regarding the outcomes in IPF compared to other conditions. This study compares the short-term outcomes of LTx in IPF versus non-IPF as well as single lung transplant (SLT) versus bilateral lung transplant (BLT) in IPF patients in a large nationally representative sample.Methods: We performed a secondary analysis of the Nationwide Inpatient Sample (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Patients aged 21 and above who underwent LTx during this period were included. The five post-operative outcomes evaluated were inpatient mortality (IM), transplant-related complications (TC), non-transplant related (NTC) complications during inpatient stay, length of stay (LOS) more than 14 days and any non-routine discharge (ND) destination.Results: There were 1845 patients who underwent LTx during the analysis period. Controlling for confounders, and compared to non-IPF patients, IPF patients were more likely to be in hospital more than 14 days (OR ¼ 1.75; 95% CI ¼ 1.31, 2.36; p £ 0.001); as likely to have inpatient mortality (OR ¼ 1.00; 95% CI ¼ 0.58, 1.72) and non-routine discharge (OR ¼ 0.95; 95% CI ¼ 0.73, 1.50); and not significantly less likely to have transplant-related complications (OR ¼ 0.82; 95% CI ¼ 0.57, 1.17) and non-transplant related complications (OR ¼ 0.89; 95% CI ¼ 0.65, 1.22). IPF patients who underwent BLT were significantly more likely to develop transplant-related complications (OR ¼ 2.52; 95% CI ¼ 1.06, 5.97; p ¼ 0.035) and non-transplant related complications (OR ¼ 2.22; 95% CI ¼ 1.17, 4.24; p ¼ 0.015); and not significantly more likely to have inpatient mortality (OR ¼ 2.24; 95% CI ¼ 0.80, 6.27), length of stay longer than 14 days (OR ¼ 1.84; 95% CI ¼ 0.83, 4.11) and nonroutine discharge (OR ¼ 1.15; 95% CI ¼ 0.44, 1.69).Conclusions: This paper demonstrated that in this population of patients in the United States, there was an increased risk of greater LOS for IPF patients. BLT in IPF patients had a significantly higher risk for inpatient complications.

Lung transplantation in idiopathic pulmonary fibrosis: a systematic review of the literature

“…An analysis of transplants among IPF patients from 2006 – 2010 included in the Spanish Lung Transplant Registry reported 3-month post-transplant survival of ~80% and 1-year survival of ~63% [ 27 ]. An analysis of the US Nationwide Inpatient Sample from 1988 to 2006 found that in-hospital survival among IPF patients who received lung transplants was 91% [ 28 ].…”

“…Two papers reported data on post-transplant in-patient mortality. From an analysis of the US National Inpatient Sample database, in-hospital death was significantly ( P = 0.006) greater following SLT (16%) vs. BLT (5%) [ 28 ]. From a small single center study from the US that included 45 IPF patients, there was no significant difference in in-hospital mortality between BLT (9.4%) and SLT (9.4%) [ 41 ].…”