LUNG TRANSPLANTATION FOR IDIOPATHIC PULMONARYFIBROSIS: WHICH PATIENTS SHOULD BE TRANSPLANTEDFIRST?

AIM The results of lung transplantation (LTX) for Idiopathic Pulmonary Fibrosis (IPF)at a single institution are retrospectively reviewed and analyzed. An attempt is madeto identify which patients are at increased risk not to survive until time of LTX.METHODS The results of LTX are presented and survival analysis (uni-and multivariate)is performed on LTX recipients (group1).Secondarily, we looked for possible predictorsof death on the waiting list (WL) before LTX, by comparing with logistic regressionpre-operative data of group1 and group2 (patients died on the WL). Parameters analyzedare shown in table1.RESULTS Between 11/83 and 7/03, 68 LTX (45M and 23F) were performed for IPF: 62single LTX (91%), 5 double LTX (7%) and 1 heart-LTX. Age was 54.5±9.6 yrs(mean±SD).Mean time on the WL was 430±384.7 days. Perioperative (30 days) survival was 94%.Actuarial survival at 6 months,1 yr and 5 yrs was respectively 84.5%, 77.8%, 60.7%.Mean hospitalization time was 28.5±23 days. The main cause of death was from infectiouscomplications. Bronchiolitis obliterans developed in 13% of patients. There was nosurvival benefit between single or double LTX. Analysis of survival in group 1 revealedthat sex (F), shorter ischemic time and ICU LOS and greater DLCO% at time of evaluationwere associated with better survival. Multivariate analysis of preoperative parameters(group 1 vs.2) showed significant association between death on the WL and: shorter6-min walking distance (6-WD), history of CAD, longer time between diagnosis andreferral.CONCLUSION Our results demonstrate excellent outcome for LTX for IPF comparedto standard benchmarks.Death on the WL was associated with some marker of advanceddisease at evaluation (6-WD, CAD, delayed referral) but not pulmonary HTN or elevatedpCO2. This data may help to identify the best transplant candidates and the best timingfor LTX.Further analysis may reveal other factors.