ILD patients awaiting lung transplant experience poor outcomes
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.