Original article
General thoracic
Lung Transplantation for Idiopathic Pulmonary Fibrosis

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
https://doi.org/10.1016/j.athoracsur.2007.04.096Get rights and content

Background

Outcomes of lung transplantation for idiopathic pulmonary fibrosis (IPF) are thought to be worse than those for other indications, although the reasons are unknown. In addition, the choice of single versus double lung transplantation is unclear. To guide decision-making, we (1) compared survival of patients receiving transplantation for IPF with survival of patients receiving transplantation for non-IPF diagnoses, (2) identified risk factors for mortality after transplantation for IPF, and (3) ascertained whether double lung transplantation for IPF confers a survival advantage.

Methods

From February 1990 to November 2005, 469 patients underwent lung transplantation, 82 for IPF. Multiphase hazard modeling was used to identify risk factors, and propensity matching was used to compare survival of IPF and non-IPF patients and to assess the effect of single versus double lung transplantation.

Results

Survival estimates after transplantation for IPF were 95%, 73%, 56%, and 44% at 30 days and 1, 3, and 5 years, somewhat worse than for matched non-IPF patients (p = 0.03). Risk factors for mortality were earlier date of transplantation (p = 0.07), single lung transplantation (p = 0.03), and higher wedge pressure (p = 0.003). Survival for double versus single lung transplantation was 81% versus 67% at 1 year and 55% versus 34% at 5 years; however, among matched non-IPF patients, corresponding survivals were 88% versus 71% at 1 year and 72% versus 48% at 5 years (p = 0.3).

Conclusions

Survival after lung transplantation for IPF is worse than after other indications for transplantation when multiple clinical variables are accounted for. Survival may be improved by double lung transplant.

Section snippets

Patients

From February 1990 to November 2005, 469 patients underwent primary lung transplantation for end-stage lung disease at Cleveland Clinic, exclusive of heart–lung transplantation. Eighty-two patients (17%) fulfilled the criteria for IPF as outlined by the American Thoracic Society [9]. Thirty-two (39%) of the 82 IPF patients underwent double lung transplantation.

Recipient, donor, and surgical data were extracted from the Unified Transplant Database, which has been approved for use in research by

Idiopathic Pulmonary Fibrosis Versus Non–Idiopathic Pulmonary Fibrosis Survival Comparison

Risk-unadjusted survival after transplantation for IPF was 95%, 73%, 56%, 44%, and 36% at 30 days and 1, 3, 5, and 7 years, which was similar to 95%, 81%, 61%, 48%, and 38% at these same intervals after transplantation for non-IPF indications (p[early hazard phase] = 0.6, p[late hazard phase] = 0.5; Fig 1A). Instantaneous risk of death after lung transplantation for both IPF and non-IPF consisted of two hazard phases that differed early, but fell to equivalent levels after about 6 months, with

Comment

Lung transplantation for IPF has been shown to confer a survival benefit over best medical therapy, but survival appears to be worse than that for non-IPF indications without clear explanation [2, 15]. In addition, whether or not survival is worse with single versus double lung transplantation remains unclear. Although multi-institutional studies focusing on these questions have benefited from large numbers for statistical analysis, they have included centers with varied experience with

References (29)

Cited by (110)

  • Awareness of bias in lung transplant registry analyses

    2020, Journal of Heart and Lung Transplantation
View all citing articles on Scopus
View full text