Lung transplantation for interstitial lung disease : benefits and prognostic factors_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIAN Qiaoyan , XU Xin , LUO Qun , WEI Bin , CHEN Ao , PENG Guilin , HUANG Danxia , HE Jianxing ,  JU Chunrong

The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

JU Chunrong, Email: juchunrong@126.com

Keywords：

Interstitial lung disease; Lung transplantation

DOI：

10.7507/1671-6205.201806019

Video：

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Objective To analyze the benefits of lung transplantation in the treatment of interstitial lung disease (ILD) and investigate its prognostic factors.Methods The clinical data of patients diagnosed with ILD and meet the lung transplantation criteria were retrospectively analyzed from January 2012 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University. A total of 111 patients, 88 males and 23 females, aged (58.3±11.4) years old, were divided into lung transplantation group and non-lung transplantation group. Clinical data and prognosis of the two groups were compared and the factors affecting the prognosis of lung transplantation were analyzed with relevant literatures. Results There were 56 patients in lung transplantation group and 55 patients in non-lung transplantation group. The mainly underlying disease of both groups were idiopathic pulmonary fibrosis (IPF). There was no significant difference in age, body mass index, arterial partial pressure of oxygen, percentage of forced vital capacity in the estimated value, percentage of diffusing capacity of the lung for carbon monoxide in the estimated value, six-minute walk distance between the two groups (P>0.05). The pulmonary arterial hypertension and arterial partial pressure of carbondioxide were higher in lung transplantation group than non-transplantation group (P<0.05). The 1-year survival rate in the lung transplantation group was significantly higher than that in the non-lung transplantation group: 77.4% vs. 32.7% (P<0.01). COX regression analysis showed that preoperative ventilator dependence, serum creatinine, bilirubin, pulmonary artery pressure, and procedures (single lung vs. double lung) had no significant effect on the prognosis of lung transplantation; age and preoperative diabetes mellitus were risk factors for the prognosis of lung transplantation.Conclusions Lung transplantation can significantly improve the prognosis of patients with ILD who are refractory to medicine therapy. IPF patients should be advised to consider lung transplantation as soon as possible. Age and preoperative diabetes mellitus are risk factors for the prognosis of lung transplantation.

Citation： LIAN Qiaoyan, XU Xin, LUO Qun, WEI Bin, CHEN Ao, PENG Guilin, HUANG Danxia, HE Jianxing, JU Chunrong. Lung transplantation for interstitial lung disease : benefits and prognostic factors. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(2): 134-139. doi: 10.7507/1671-6205.201806019 Copy

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2.	Wallis A, Spinks K. The diagnosis and management of interstitial lung diseases. BMJ, 2015, 350: h2072.
3.	Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2015, 34(1): 1-15.
4.	Berastegui C, Monforte V, Bravo C, et al. Lung transplantation in pulmonary fibrosis and other interstitial lung diseases. Med Clin (Barc), 2014, 143(6): 239-244.
5.	Thabut G, Mal H, Castier Y, et al. Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis. J Thorac Cardiovasc Surg, 2003, 126(2): 469-475.
6.	Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant, 2016, 35(4): 433-439.
7.	https://optn.transplant.hrsa.gov/resources/allocation-calculators/las-calculator/.
8.	Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age. J Heart Lung Transplant, 2013, 32(10): 965-978.
9.	Ye X, Kuo HT, Sampaio MS, et al. Risk factors for development of new-onset diabetes mellitus after transplant in adult lung transplant recipients. Clin Transplant, 2011, 25(6): 885-891.
10.	Klomjit N, Mehrnia A, Sampaio M, et al. Impact of diabetes mellitus on survival outcome of lung transplant recipients: an analysis of OPTN/UNOS Data. Clin Transpl, 2015, 31: 43-55.
11.	Plantier L, Skhiri N, Biondi G, et al. Impact of previous cardiovascular disease on the outcome of lung transplantation. J Heart Lung Transplant, 2010, 29(11): 1270-1276.
12.	Higo H, Kurosaki T, Ichihara E, et al. Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list. Respir Investig, 2017, 55(4): 264-269.
13.	Leslie KO, Cool CD, Sporn TA, et al. Familial idiopathic interstitial pneumonia: histopathology and survival in 30 patients. Arch Pathol Lab Med, 2012, 136(11): 1366-1376.
14.	Ikezoe K, Handa T, Tanizawa K, et al. Prognostic factors and outcomes in Japanese lung transplant candidates with interstitial lung disease. PLoS One, 2017, 12(8): e183171.
15.	Martinu T, Babyak MA, O'Connell CF, et al. Baseline 6-min walk distance predicts survival in lung transplant candidates. Am J Transplant, 2008, 8(7): 1498-1505.
16.	Lederer DJ, Wilt JS, D'Ovidio F, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med, 2009, 180(9): 887-895.
17.	Ruttens D, Verleden SE, Vandermeulen E, et al. Body mass index in lung transplant candidates: a contra-indication to transplant or not?. Transplant Proc, 2014, 46(5): 1506-1510.
18.	Villavicencio MA, Axtell AL, Osho A, et al. Single versus double lung transplantation in pulmonary fibrosis: impact of age and pulmonary hypertension. Ann Thorac Surg, 2018, 106(3): 856-863.
19.	Schaffer JM, Singh SK, Reitz BA, et al. Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need. JAMA, 2015, 313(9): 936-948.
20.	De Oliveira NC, Osaki S, Maloney J, et al. Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation. Interact Cardiovasc Thorac Surg, 2012, 14(3): 263-267.
21.	Raghu G, Rochwerg B, Zhang Y, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med, 2015, 192(2): e3-e19.
22.	孙敏, 李慧星, 谢于峰, 等. 单肺与双肺移植治疗特发性肺间质纤维化的临床研究. 中华结核和呼吸杂志, 2016, 39(6): 444-449.

1. Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart-Lung Transplant Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
2. Wallis A, Spinks K. The diagnosis and management of interstitial lung diseases. BMJ, 2015, 350: h2072.
3. Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2015, 34(1): 1-15.
4. Berastegui C, Monforte V, Bravo C, et al. Lung transplantation in pulmonary fibrosis and other interstitial lung diseases. Med Clin (Barc), 2014, 143(6): 239-244.
5. Thabut G, Mal H, Castier Y, et al. Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis. J Thorac Cardiovasc Surg, 2003, 126(2): 469-475.
6. Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant, 2016, 35(4): 433-439.
7. https://optn.transplant.hrsa.gov/resources/allocation-calculators/las-calculator/.
8. Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age. J Heart Lung Transplant, 2013, 32(10): 965-978.
9. Ye X, Kuo HT, Sampaio MS, et al. Risk factors for development of new-onset diabetes mellitus after transplant in adult lung transplant recipients. Clin Transplant, 2011, 25(6): 885-891.
10. Klomjit N, Mehrnia A, Sampaio M, et al. Impact of diabetes mellitus on survival outcome of lung transplant recipients: an analysis of OPTN/UNOS Data. Clin Transpl, 2015, 31: 43-55.
11. Plantier L, Skhiri N, Biondi G, et al. Impact of previous cardiovascular disease on the outcome of lung transplantation. J Heart Lung Transplant, 2010, 29(11): 1270-1276.
12. Higo H, Kurosaki T, Ichihara E, et al. Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list. Respir Investig, 2017, 55(4): 264-269.
13. Leslie KO, Cool CD, Sporn TA, et al. Familial idiopathic interstitial pneumonia: histopathology and survival in 30 patients. Arch Pathol Lab Med, 2012, 136(11): 1366-1376.
14. Ikezoe K, Handa T, Tanizawa K, et al. Prognostic factors and outcomes in Japanese lung transplant candidates with interstitial lung disease. PLoS One, 2017, 12(8): e183171.
15. Martinu T, Babyak MA, O'Connell CF, et al. Baseline 6-min walk distance predicts survival in lung transplant candidates. Am J Transplant, 2008, 8(7): 1498-1505.
16. Lederer DJ, Wilt JS, D'Ovidio F, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med, 2009, 180(9): 887-895.
17. Ruttens D, Verleden SE, Vandermeulen E, et al. Body mass index in lung transplant candidates: a contra-indication to transplant or not?. Transplant Proc, 2014, 46(5): 1506-1510.
18. Villavicencio MA, Axtell AL, Osho A, et al. Single versus double lung transplantation in pulmonary fibrosis: impact of age and pulmonary hypertension. Ann Thorac Surg, 2018, 106(3): 856-863.
19. Schaffer JM, Singh SK, Reitz BA, et al. Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need. JAMA, 2015, 313(9): 936-948.
20. De Oliveira NC, Osaki S, Maloney J, et al. Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation. Interact Cardiovasc Thorac Surg, 2012, 14(3): 263-267.
21. Raghu G, Rochwerg B, Zhang Y, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med, 2015, 192(2): e3-e19.
22. 孙敏, 李慧星, 谢于峰, 等. 单肺与双肺移植治疗特发性肺间质纤维化的临床研究. 中华结核和呼吸杂志, 2016, 39(6): 444-449.

Chinese Journal of Respiratory and Critical Care Medicine

Lung transplantation for interstitial lung disease : benefits and prognostic factors

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