Open AccessDeterminants of survival in lung transplantation patients with idiopathic pulmonary fibrosis: a retrospective cohort study
Author(s) -
Tuyls Sebastiaan,
Verleden Stijn E.,
Wuyts Wim A.,
Yserbyt Jonas,
Vos Robin,
Verleden Geert M.
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13382
Subject(s) - medicine , lung transplantation , idiopathic pulmonary fibrosis , hazard ratio , retrospective cohort study , cohort , dlco , lung , gastroenterology , transplantation , proportional hazards model , corticosteroid , surgery , diffusing capacity , confidence interval , lung function
Summary Survival after lung transplantation (LTx) for idiopathic pulmonary fibrosis (IPF) is worse compared to other indications for LTx. We investigated the effect of several pretransplant variables including the use of pretransplant corticosteroids (CS) on post‐transplant graft and chronic lung allograft dysfunction (CLAD)‐free survival and functional testing (maximum inspiratory and expiratory pressure, six‐minute walk test, quadriceps and hand pinch force) in a small cohort of IPF patients. We retrospectively compared two groups of IPF patients ( n = 36 on CS vs. n = 18 not on CS) who underwent LTx between 2000 and 2016. Analysis of 54 IPF‐LTx patients showed no significant effect on graft survival or functional tests except for maximum inspiratory pressure ( P = 0.033) between these two groups (all LTx patients, CS vs. no CS). Regression analysis showed significant impact of procedure with a hazard ratio of 0.423 (CI 95% 0.194, 0.924) favoring sequential single LTx (SSLTx) compared to single lung transplantation (SLTx). When analyzing only the 40 SSLTx patients, corticosteroid‐free patients showed significantly better graft survival compared to patients on CS ( P = 0.045) and CLAD‐free survival ( P = 0.019). The possible detrimental effect of corticosteroid therapy before LTx was demonstrated in this cohort of SSLTx patients, which questions the use of corticosteroids in a pretransplantation setting.