Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis.
OBJECTIVE
Although lung transplantation is viewed as an acceptable option for patients with end-stage idiopathic pulmonary fibrosis, the survival benefit of this approach is still debated. This study examined whether there was a survival benefit of lung transplantation in a cohort of patients referred to our transplant center with a diagnosis of idiopathic pulmonary fibrosis according to American Thoracic Society criteria.


METHODS
Forty-six patients accepted for lung transplantation during a 12-year period with a diagnosis of idiopathic pulmonary fibrosis form the basis of this study. Survival benefit offered by lung transplantation was assessed using Cox proportional-hazards modeling, with patients on a waiting list as the control group.


RESULTS
Twenty-eight patients underwent lung transplantation (27 single and 1 double), 16 patients died while waiting, and 2 patients remained on the active waiting list. Diagnosis of idiopathic pulmonary fibrosis was made on histologic examination of the explanted lung or lung biopsy before lung transplantation. There was a pattern of usual interstitial pneumonia in 31 cases (67%). The 15 remaining patients fulfilled all American Thoracic Society criteria for idiopathic pulmonary fibrosis. The median waiting time for organs was 51 days. Survival after lung transplantation was 79.4% at 1 year, 63.5% at 2 years, and 39% at 5 years. The multivariable analysis showed that lung transplantation reduced the risk of death by 75% (95% confidence interval, 8%-86%; P =.03) after adjustment on potential confounding variables.


CONCLUSIONS
Lung transplantation is effective in improving the survival of selected patients affected by idiopathic pulmonary fibrosis.
Thabut
Gabriel
G
Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110 Clichy, France. gabriel.thabut@bjn.ap-hop-paris.fr
Mal
Hervé
H
Castier
Yves
Y
Groussard
Odile
O
Brugière
Olivier
O
Marrash-Chahla
Rolana
R
Lesèche
Guy
G
Fournier
Michel
M
D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016019:Survival Analysis; D013997:Time Factors; D014109:Total Lung Capacity / Q000502:physiology; D016896:Treatment Outcome; D014850:Waiting Lists