Ryan M Kern1, Jonathan P Singer2, Laura Koth2, Joshua Mooney3, Jeff Golden2, Steven Hays2, John Greenland2, Paul Wolters2, Emily Ghio2, Kirk D Jones4, Lorriana Leard2, Jasleen Kukreja3, Paul D Blanc5. 1. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco. Electronic address: ryanmkern@gmail.com. 2. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco. 3. Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA. 4. Department of Pathology, Pulmonary Pathology and Cytopathology University of California San Francisco, San Francisco. 5. Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco; Division of Occupational and Environmental Medicine, University of California San Francisco; Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA.
Abstract
BACKGROUND: Hypersensitivity pneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may necessitate the need for lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared with referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF). METHODS: To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000 to 2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to referents with IPF. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling. RESULTS: We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared with IPF was 96%, 89%, and 89% vs 86%, 67%, and 49%, respectively. Subjects with HP manifested a reduced adjusted risk for death compared with subjects with IPF (hazard ratio, 0.25; 95% CI, 0.08-0.74; P = .013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in five (16%). Two subjects developed recurrent HP in their allografts. CONCLUSIONS: Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk for death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.
BACKGROUND:Hypersensitivitypneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may necessitate the need for lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared with referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF). METHODS: To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000 to 2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to referents with IPF. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling. RESULTS: We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared with IPF was 96%, 89%, and 89% vs 86%, 67%, and 49%, respectively. Subjects with HP manifested a reduced adjusted risk for death compared with subjects with IPF (hazard ratio, 0.25; 95% CI, 0.08-0.74; P = .013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in five (16%). Two subjects developed recurrent HP in their allografts. CONCLUSIONS: Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk for death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.
Authors: Evans R Fernández Pérez; Jeffrey J Swigris; Anna V Forssén; Olga Tourin; Joshua J Solomon; Tristan J Huie; Amy L Olson; Kevin K Brown Journal: Chest Date: 2013-11 Impact factor: 9.410
Authors: Roger D Yusen; Jason D Christie; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Anne I Dipchand; Fabienne Dobbels; Richard Kirk; Lars H Lund; Axel O Rahmel; Josef Stehlik Journal: J Heart Lung Transplant Date: 2013-10 Impact factor: 10.247
Authors: B Etienne; M Bertocchi; J P Gamondes; F Thévenet; C Boudard; T Wiesendanger; R Loire; J Brune; J F Mornex Journal: Am J Respir Crit Care Med Date: 1998-01 Impact factor: 21.405
Authors: Peter D Sottile; David Iturbe; Tamiko R Katsumoto; M Kari Connolly; Harold R Collard; Lorriana A Leard; Steven Hays; Jeffrey A Golden; Charles Hoopes; Jasleen Kukreja; Jonathan P Singer Journal: Transplantation Date: 2013-04-15 Impact factor: 4.939
Authors: Joshua J Mooney; Brett M Elicker; Thomas H Urbania; Misha R Agarwal; Christopher J Ryerson; Michelle Linh T Nguyen; Prescott G Woodruff; Kirk D Jones; Harold R Collard; Talmadge E King; Laura L Koth Journal: Chest Date: 2013-08 Impact factor: 9.410
Authors: Hans Henrik Lawaetz Schultz; C B Andersen; D Steinbruuchel; M Perch; J Carlsen; M Iversen Journal: Sarcoidosis Vasc Diffuse Lung Dis Date: 2014-07-08 Impact factor: 0.670
Authors: Haruhiko Furusawa; Jonathan H Cardwell; Tsukasa Okamoto; Avram D Walts; Iain R Konigsberg; Jonathan S Kurche; Tami J Bang; Marvin I Schwarz; Kevin K Brown; Jonathan A Kropski; Mauricio Rojas; Carlyne D Cool; Joyce S Lee; Paul J Wolters; Ivana V Yang; David A Schwartz Journal: Am J Respir Crit Care Med Date: 2020-11-15 Impact factor: 21.405
Authors: Margaret L Salisbury; Jeffrey L Myers; Elizabeth A Belloli; Ella A Kazerooni; Fernando J Martinez; Kevin R Flaherty Journal: Am J Respir Crit Care Med Date: 2017-09-15 Impact factor: 21.405
Authors: Andrea L Magee; Steven M Montner; Aliya Husain; Ayodeji Adegunsoye; Rekha Vij; Jonathan H Chung Journal: Radiol Clin North Am Date: 2016-08-11 Impact factor: 2.303
Authors: Brett Ley; Chad A Newton; Isabel Arnould; Brett M Elicker; Travis S Henry; Eric Vittinghoff; Jeffrey A Golden; Kirk D Jones; Kiran Batra; Jose Torrealba; Christine Kim Garcia; Paul J Wolters Journal: Lancet Respir Med Date: 2017-06-22 Impact factor: 30.700
Authors: Ganesh Raghu; Martine Remy-Jardin; Christopher J Ryerson; Jeffrey L Myers; Michael Kreuter; Martina Vasakova; Elena Bargagli; Jonathan H Chung; Bridget F Collins; Elisabeth Bendstrup; Hassan A Chami; Abigail T Chua; Tamera J Corte; Jean-Charles Dalphin; Sonye K Danoff; Javier Diaz-Mendoza; Abhijit Duggal; Ryoko Egashira; Thomas Ewing; Mridu Gulati; Yoshikazu Inoue; Alex R Jenkins; Kerri A Johannson; Takeshi Johkoh; Maximiliano Tamae-Kakazu; Masanori Kitaichi; Shandra L Knight; Dirk Koschel; David J Lederer; Yolanda Mageto; Lisa A Maier; Carlos Matiz; Ferran Morell; Andrew G Nicholson; Setu Patolia; Carlos A Pereira; Elisabetta A Renzoni; Margaret L Salisbury; Moises Selman; Simon L F Walsh; Wim A Wuyts; Kevin C Wilson Journal: Am J Respir Crit Care Med Date: 2020-08-01 Impact factor: 30.528