Long-term survival of lung transplantation for interstitial lung disease associated with connective tissue diseases: a study of 26 cases from a referral centre.

Abstract

OBJECTIVES:

Interstitial lung disease (ILD) is a leading cause of mortality in patients with connective tissue diseases (CTD). Lung transplantation has become a viable option for patients with end-stage CTD-ILD. However, patients with CTD are often considered suboptimal candidates for lung transplantation because of concerns of worse outcomes. We assessed post-transplant survival of patients with CTD-ILD compared to patients with idiopathic pulmonary fibrosis (IPF).

METHODS:

Medical records of patients who underwent lung transplantation for CTD-ILD at a single referral centre for lung transplantation in Northern Spain between 1998 and 2018 were reviewed. This cohort was compared with patients with IPF (group-matched for age ±3.3 years, transplant year and use of basiliximab induction previous to transplant). Cumulative survival rates after transplantation were estimated by the Kaplan-Meier method and compared between groups using the log-rank test.

RESULTS:

We studied 26 patients with CTD-ILD and 26 patients with IPF. The underlying diseases of CTD-ILD patients were rheumatoid arthritis (n=9), scleroderma (n=6), Sjögren's syndrome (n=4), ANCA-associated vasculitis (n=3), anti-synthetase syndrome (n=2), and dermatomyositis, systemic lupus erythematosus (1 each). Baseline characteristics were similar in both groups. CTD-ILD patients experienced acute graft rejection less commonly than those with IPF (32.0% vs. 62.5%; p=0.032). However, a non-statistically significant increased frequency of chronic graft rejection was observed in CTD-ILD patients (20.0% vs. 8.3%; p=0.417). In this regard, the 5-year cumulative survival rates after transplantation was reduced in CTD-ILD (42.4% vs. 65.8%) but the difference did not achieve statistical significance (p=0.075).

CONCLUSIONS:

Long-term post-transplant survival in Northern Spanish patients with CTD-ILD is reduced compared with IPF.

• Authors: Diana Prieto-Peña, Amaya Martínez-Meñaca, Mónica Calderón-Goercke, Víctor M Mora-Cuesta, Sonia Fernández-Rozas, David Iturbe-Fernández, José J Gómez-Román, Jose M Cifrián-Martínez, Santos Castañeda, Jose L Hernández, Miguel A González-Gay, Ricardo Blanco
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2020 Jul-Aug Vol. 38 Issue 4 Pg. 615-620 ISSN: 0392-856X [Print] Italy
• PMID: 31694743 (Publication Type: Journal Article)

Topics

• Connective Tissue Diseases
• Humans
• Lung Diseases, Interstitial
• Lung Transplantation
• Prognosis
• Referral and Consultation
• Spain