Maria M Crespo1, Christian A Bermudez2, Mary Amanda Dew3, Bruce A Johnson1, M Patricia George1, Jay Bhama4, Matthew Morrell1, Jonathan D'Cunha5, Norihisa Shigemura5, Thomas J Richards5, Joseph M Pilewski1. 1. 1 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine. 2. 2 Department of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; and. 3. 3 Department of Psychiatry, University of Pittsburgh Medical Center and University of Pittsburgh, Pittsburgh, Pennsylvania. 4. 4 Department of Cardiothoracic Surgery, University of Iowa, Iowa City, Iowa. 5. 5 Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, and.
Abstract
RATIONALE: Patients with advanced lung disease due to systemic sclerosis have long been considered suboptimal and often unacceptable candidates for lung transplant. OBJECTIVES: To examine post-lung transplant survival of patients with systemic sclerosis compared with patients with pulmonary fibrosis and to identify risk factors for 1-year mortality. METHODS: In a retrospective cohort study, we compared post-lung transplant outcomes of 72 patients with scleroderma with those of 311 patients with pulmonary fibrosis between June 2005 and September 2013 at our institution. Actuarial survival estimates were calculated using Kaplan-Meier curves. In Cox regression models, we determined risk factors for post-transplant mortality, controlling for whether patients had scleroderma or pulmonary fibrosis. MEASUREMENTS AND MAIN RESULTS: Post-transplant survival did not differ significantly between scleroderma and pulmonary fibrosis at year 1 (81% scleroderma vs. 79% pulmonary fibrosis; P = 0.743), at year 5 conditional on 1-year survival (66% vs. 58%; P = 0.249), or overall (P = 0.385). In multivariate analysis, body mass index greater than or equal to 35 kg/m(2) predicted poor 1-year survival in pulmonary fibrosis (hazard ratio, 2.76; P = 0.003). Acute cellular rejection-free survival did not differ significantly between the scleroderma and pulmonary fibrosis cohorts. Patients with scleroderma had significantly better bronchiolitis obliterans syndrome stage 1 or higher-free survival than did patients with pulmonary fibrosis. CONCLUSIONS: Our findings that 1- and 5-year survival rates of patients with scleroderma were similar to those of patients with pulmonary fibrosis indicate that lung transplant is a reasonable treatment option in selected patients with scleroderma.
RATIONALE: Patients with advanced lung disease due to systemic sclerosis have long been considered suboptimal and often unacceptable candidates for lung transplant. OBJECTIVES: To examine post-lung transplant survival of patients with systemic sclerosis compared with patients with pulmonary fibrosis and to identify risk factors for 1-year mortality. METHODS: In a retrospective cohort study, we compared post-lung transplant outcomes of 72 patients with scleroderma with those of 311 patients with pulmonary fibrosis between June 2005 and September 2013 at our institution. Actuarial survival estimates were calculated using Kaplan-Meier curves. In Cox regression models, we determined risk factors for post-transplant mortality, controlling for whether patients had scleroderma or pulmonary fibrosis. MEASUREMENTS AND MAIN RESULTS: Post-transplant survival did not differ significantly between scleroderma and pulmonary fibrosis at year 1 (81% scleroderma vs. 79% pulmonary fibrosis; P = 0.743), at year 5 conditional on 1-year survival (66% vs. 58%; P = 0.249), or overall (P = 0.385). In multivariate analysis, body mass index greater than or equal to 35 kg/m(2) predicted poor 1-year survival in pulmonary fibrosis (hazard ratio, 2.76; P = 0.003). Acute cellular rejection-free survival did not differ significantly between the scleroderma and pulmonary fibrosis cohorts. Patients with scleroderma had significantly better bronchiolitis obliterans syndrome stage 1 or higher-free survival than did patients with pulmonary fibrosis. CONCLUSIONS: Our findings that 1- and 5-year survival rates of patients with scleroderma were similar to those of patients with pulmonary fibrosis indicate that lung transplant is a reasonable treatment option in selected patients with scleroderma.
Authors: Miguel M Leiva-Juárez; Andreacarola Urso; Joseph Costa; Bryan P Stanifer; Joshua R Sonett; Luke Benvenuto; Megan Aversa; Hilary Robbins; Lori Shah; Selim Arcasoy; Frank D'Ovidio Journal: J Scleroderma Relat Disord Date: 2021-05-25
Authors: Alicia M Hinze; Cheng T Lin; Amira F Hussien; Jamie Perin; Aida Venado; Jeffrey A Golden; Francesco Boin; Robert H Brown; Robert A Wise; Fredrick M Wigley Journal: Rheumatology (Oxford) Date: 2020-04-01 Impact factor: 7.580
Authors: Jake G Natalini; Joshua M Diamond; Mary K Porteous; David J Lederer; Keith M Wille; Ann B Weinacker; Jonathan B Orens; Pali D Shah; Vibha N Lama; John F McDyer; Laurie D Snyder; Chadi A Hage; Jonathan P Singer; Lorraine B Ware; Edward Cantu; Michelle Oyster; Laurel Kalman; Jason D Christie; Steven M Kawut; Elana J Bernstein Journal: J Heart Lung Transplant Date: 2021-01-23 Impact factor: 10.247