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ILD patients awaiting lung transplant experience poor outcomes

27 Aug 2017

Japanese patients with interstitial lung disease (ILD) awaiting lung transplant suffer from poor outcomes, a new study has shown. Particularly, those with idiopathic pulmonary fibrosis (IPF) tend to have atypical high-resolution computed tomography (HRCT) patterns.

The study included 77 consecutive ILD patients (mean age 49.0±9.0 years; 62 percent male) awaiting a lung transplant. Diagnosis of IPF was based on lung biopsies and HCRT. Clinical and background data were obtained from lung transplantation databases.

Participants underwent pulmonary function tests, single-breath technique and the 6-minute walk test (6MWT). Cox proportional hazards model followed by Fine and Gray subdistribution hazard models were used to determine factors that predict mortality.

In the multivariate stepwise analysis, 6MWT significantly predicted mortality (hazard ratio [HR], 0.97 for every 10 m increase; 95 percent CI, 0.95 to 0.99; p<0.01) regardless of selected covariates. Fine and Gray subdistribution confirmed the contribution of 6MWT to mortality (HR, 0.95 for each 10 m, increase; 0.95 to 0.99; p<0.01).

Kaplan-Meier survival curves showed that those with <250 m in the 6MWT had significantly shorter survival compared with those who had ≥250 m (p<0.01).

Stepwise multivariate Cox proportional hazards in the IPF patients (n=33) revealed that a history of acute exacerbation (HR, 4.50; 1.15 to 17.66; p=0.03) and BMI (HR, 0.83; 0.72 to 0.95; p<0.01) were both significantly associated with mortality.

Of the 77 included patients, 69 percent (n=53) had idiopathic interstitial pneumonia while 22 percent (n=17) had connective tissue disease-associated ILD (CTD-ILD). The remaining 9 percent (n=7) were diagnosed with chronic hypersensitivity pneumonia. Lung transplants were performed in 23 patients, of which 20 were cadaveric while three were from living donors.

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Most Read Articles
2 days ago
Combining the DASH (Dietary Approaches to Stop Hypertension) diet with low sodium intake reduces systolic blood pressure (SBP) in individuals with pre- and stage 1 hypertension, with progressively higher reductions at greater levels of baseline SBP, a recent study has shown.
5 days ago
Cognitive deficits in bipolar disorder are neurodevelopmental rather than neurodegenerative in nature, a recent study has reported. Furthermore, cognitive impairment in bipolar patients appears to be stable, in the majority at least.
Yesterday
Tadalafil may not be effective for reducing the decline in ambulatory ability in boys with Duchenne muscular dystrophy (DMD), as shown in a recent study.
4 days ago
Hydrochlorothiazide (HCTZ) appears to significantly increase the risks of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma (SCC), a recent study has shown.