title: Lung transplantation for hypersensitivity pneumonitis.
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.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco. Electronic address: ryanmkern@gmail.com.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Kern
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Singer
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Laura
authors.initials: L
authors.lastname: Koth
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mooney
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Jeff
authors.initials: J
authors.lastname: Golden
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Steven
authors.initials: S
authors.lastname: Hays
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: John
authors.initials: J
authors.lastname: Greenland
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Paul
authors.initials: P
authors.lastname: Wolters
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Emily
authors.initials: E
authors.lastname: Ghio
authors.affiliation: Department of Pathology, Pulmonary Pathology and Cytopathology University of California San Francisco, San Francisco.
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Jones
authors.affiliation: Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
authors.forename: Lorriana
authors.initials: L
authors.lastname: Leard
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA.
authors.forename: Jasleen
authors.initials: J
authors.lastname: Kukreja
authors.affiliation: 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.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blanc
mesh_terms: D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000401:mortality / Q000601:surgery; D008168:Lung / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome