Article Text

other Versions

  • You are currently viewing an earlier version of this article (June 15, 2007).

PDF

Rate of disease progression in patients with pulmonary fibrosis: a trigger for referral for lung transplantation.
  1. Laura S Mackay (laurasmackay{at}doctors.org.uk)
  1. Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
    1. Rachel L Anderson (r.anderson{at}lumc.nl)
    1. Applied Immunobiology and Transplantation Research Group, Newcastle upon Tyne, United Kingdom
      1. Gareth Parry (gareth.parry{at}nuth.nhs.uk)
      1. Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
        1. James Lordan (jim.lordan{at}nuth.nhs.uk)
        1. Applied Immunobiology and Transplantation Research Group, Newcastle upon Tyne, United Kingdom
          1. Paul A Corris (paul.corris{at}newcastle.ac.uk)
          1. Applied Immunobiology and Transplantation Research Group, Newcastle upon Tyne, United Kingdom
            1. Andrew J Fisher (a.j.fisher{at}newcastle.ac.uk)
            1. Applied Immunobiology and Transplantation Research Group, Newcastle upon Tyne, United Kingdom

              Abstract

              Introduction: Lung transplantation is the only treatment modality that provides a survival advantage in pulmonary fibrosis. However, many patients deemed suitable will die awaiting lung transplantation. While donor organ shortage undoubtedly contributes to this, late referral to the transplant centre may also play a role. This study investigates factors influencing the chance of patients with pulmonary fibrosis reaching lung transplantation.

              Methods: A single centre, retrospective review of patient demographics, assessment investigations and subsequent clinical outcomes for patients with pulmonary fibrosis assessed for lung transplantation over a 5 year period.

              Results: Between March 1999 and March 2004, 129 patients with pulmonary fibrosis underwent formal transplant assessment. Sixty-nine were accepted and listed for lung transplantation. Of these, 17 were transplanted, 37 died while waiting, 4 were removed from the list and 11 were still waiting at the conclusion of the study. Waiting time on the list for those transplanted was median (range) 103 (6-904) days compared with 125 (2-547) days among those dying on the list, P=0.65. There was no significant difference in age, spirometry, total lung capacity, gas transfer measures or 6 minute walk distance between those who died waiting and those transplanted. However, time from onset of symptoms to transplant assessment was significantly less among those who died waiting, median (range) 29 (2-120) months compared with those transplanted 46 (6-204) months, P= 0.037.

              Conclusion: Patients with pulmonary fibrosis who died awaiting transplantation had similar disease severity at assessment as those who achieved transplantation. However, the interval between symptom onset and transplant referral was significantly shorter in those who died waiting, suggesting they had more rapidly progressive disease. Rate of disease progression appears a more sensitive indicator for transplantation referral than any single physiological measure of disease severity and should act as an important trigger for early transplant referral.

              • Lung Transplantation
              • Pulmonary Fibrosis

              Statistics from Altmetric.com

              Request permissions

              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.