Summary
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is currently the main indication for lung transplant (LTx) in the United States. Opinions differ regarding the outcomes in IPF compared to other conditions. This study compares the short-term outcomes of LTx in IPF versus non-IPF as well as single lung transplant (SLT) versus bilateral lung transplant (BLT) in IPF patients in a large nationally representative sample. METHODS: We performed a secondary analysis of the Nationwide Inpatient Sample (1988–2006). Patients aged 21 and above who underwent LTx during this period were included. The five post-operative outcomes evaluated were inpatient mortality (IM), transplant-related complications (TC), non-transplant related (NTC) complications during inpatient stay, length of stay (LOS) more than 14 days and any non-routine discharge (ND) destination. RESULTS: There were 1845 patients who underwent LTx during the analysis period. Controlling for confounders, and compared to non-IPF patients, IPF patients were more likely to be in hospital more than 14 days (OR = 1.75; 95% CI = 1.31, 2.36; p ≤ 0.001); as likely to have inpatient mortality (OR = 1.00; 95% CI = 0.58, 1.72) and non-routine discharge (OR = 0.95; 95% CI = 0.73, 1.50); and not significantly less likely to have transplant-related complications (OR = 0.82; 95% CI = 0.57, 1.17) and non-transplant related complications (OR = 0.89; 95% CI = 0.65, 1.22). IPF patients who underwent BLT were significantly more likely to develop transplant-related complications (OR = 2.52; 95% CI = 1.06, 5.97; p = 0.035) and non-transplant related complications (OR = 2.22; 95% CI = 1.17, 4.24; p = 0.015); and not significantly more likely to have inpatient mortality (OR = 2.24; 95% CI = 0.80, 6.27), length of stay longer than 14 days (OR = 1.84; 95% CI = 0.83, 4.11) and non-routine discharge (OR = 1.15; 95% CI = 0.44, 1.69). CONCLUSIONS: This paper demonstrated that in this population of patients in the United States, there was an increased risk of greater LOS for IPF patients. BLT in IPF patients had a significantly higher risk for inpatient complications.
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Gross TJ, Hunninghake GW. Idiopathic pulmonary fibrosis. N Engl J Med 2001;345:517–25
Danil ZD, Gilchrist FC, Nicholson AG, et al. A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med 1999; 160:899–905
Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update – a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745–55
Thabut Gl, Mal H, Castier Y, et al. Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis. J Thoracic Cardiovasc Surg 2003;126:469–75
Mason DP, Brizzio ME, Alster JM, et al. Lung transplantation for idiopathic pulmonary fibrosis. Ann Thorac Surg 2007;84:1121–8
Charman SC, Sharples LD, McNel KD, et al. Assessment of survival benefit after lung transplantation by patient diagnosis. J Heart Lung Transplant 2002;21:226–32
Sherman W, Rabkin D, Ross D, et al. Contemporary lung transplantation: the UCLA experience. Clin Transpl 2008;163–70
Trulock EP, Christie JD, Edwards LB, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult lung and heart-lung transplantation report-2007. J Heart Lung Transplant 2007;26:782–95
Bartosik W, Egan JJ, Soo A, et al. A review of the lung transplantation programme in Ireland 2005–2007. Eur J Cardiothorac Surg 2009;35:807–11
Burton CM, Milman N, Carlsen J, et al. The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart–lung transplantation. J Heart Lung Transplant 2005;24:1834–43
Lee JC, Christie JD. Primary graft dysfunction. Clin Chest Med 2011;32:279–93
Christie JD, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult lung and heart/lung transplantation report – 2008. J Heart Lung Transplant 2008;27:957–69
de Perrot MD, Chaparro C, McRae K, et al. Twenty-year experience of lung transplantation at a single center: Influence of recipient diagnosis on long-term survival. J Thorac Cardiovasc Surg 2004;127:1293–500
Weiss ES, Jeremiah GA, Merlo CA, et al. Factors indicative of long-term survival after lung transplantation: a review of 836 10-year survivors. J Heart Lung Transplant 2010;29:240–6
Glanville AR, Estenne M. Indications, patient selection and timing of referral for lung transplantation. Eur Respir J 2003; 22:845–52
Kozower BD, Meyers BF, Smith MA, et al. The impact of the lung allocation score on short-term transplantation outcomes: a multicenter study. J Thorac Cardiovasc Surg 2008;135:166–71
Merlo CA, Weiss ES, Orens JB, et al. Impact of U.S. Lung Allocation Score on survival after lung transplantation. J Heart Lung Transplant 2009;28:769–75
Pietrobon R, Guller U, Martins H, et al. A suite of web applications to streamline the interdisciplinary collaboration in secondary data analyses. BMC Med Res Methodol 2004;4:29
Shah J, Shah A, Pietrobon R. Scientific writing of novice researchers: what difficulties and encouragements do they encounter? Acad Med 2009;84:511–6
Whalen D, Houchens R, Elixhauser A. Final 2000 NIS Comparison Report. 2003. HCUP Methods Series Report # 2003-1
Whalen D, Houchens R, Elixhauser A, 2005 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. 2008. HCUP Method Series Report # 2008-01
Healthcare Cost and Utilization Project (HCUP) Quality Control Procedures, Healthcare Cost and Utilization Project, Sept. 2008. Table of Contents pp. 1–18
Healthcare Cost and Utilization Project (HCUP) website http://www.hcup-us.ahrq.gov/
Nationwide Inpatient Sample website http://www.hcup-us.ahrq.gov/nisoverview.jsp
Mallory GB, Spray TL. Paediatric lung transplantation. Eur Respir J 2004;24:839–45
Spray TL, Mallory GB, Canter CB, et al. Pediatric lung transplantation. Indications, techniques, and early results. J Thorac Cardiovasc Surg 1994;107:990–1000
Huddleston CB, Bloch JB, Sweet SC, et al. Lung transplanatation in children. Ann Surg 2002;236:270–6
Cohen AH, Sweet SC, Mendeloff EN, et al. High incidence of posttransplant lymphoproliferative disease in paediatric patients with cystic fibrosis. Am J Respir Crit Care Med 2000;161: 1252–5
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–9
Maldonado G, Greenland S. Simulation study of confounderselection strategies. Am J Epidemiol 1993;138:923–36
Lien D, Loadman M, Homan J, et al. Quality of life and functional outcomes of patients undergoing lung transplantation for pulmonary fibrosis. J Heart Lung Transplant 2008;27(Suppl. 2): S138–9
Keating D, Levvey B, Kotsimbos T, et al. Lung transplantation in pulmonary fibrosis: challenging early outcomes counterbalanced by surprisingly good outcomes beyond 15 years. Transplant Proc 2009;41:289–91
Christie JD, Edwards LB, Aurora P, et al. The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report – 2009. J Heart Lung Transplant 2009;28:1031–49
Lee JC, Christie JD, Keshavjee S. Primary graft dysfunction: definition, risk factors, short- and long-term outcomes. Semin Respir Crit Care Med 2010;31:161–71
Kroft LJ, Simons P, van Laar JM, et al. Patients with pulmonary fibrosis: cardiac function assessed with MR imaging. Radiology 2000;216:464–71
Izbicki G, Ben-Dor I, Shitrit D, et al. The prevalence of coronary artery disease in end-stage pulmonary disease: is pulmonary fibrosis a risk factor? Respir Med 2009;103:1346–9
Hubbard RB, Smith C, Le Jeune I, et al. The association between idiopathic pulmonary fibrosis and vascular disease: a population-based study. Am J Respir Crit Care Med 2008; 178:1257–61
Meyer DM, Edwards LB, Torres F, et al. Impact of recipient age and procedure type on survival after lung transplantation for pulmonary fibrosis. Ann Thorac Surg 2005;79:950–7
Hadjiliadis D, Berbrayer CS, Hadjiliadis O, et al. Survival after bilateral lung transplantation depends on the maximum lung function achieved post-transplant and the development of Bronchiolitis Obliterans Syndrome (BOS). J Heart Lung Transplant 2005;24(2S):S60
Neurohr C, Huppmann P, Thum D, et al. Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis. Transpl Int 2010;23:887–96
Christie JD, Bavaria JE, Palevsky HI, et al. Primary graft failure following lung transplantation. Chest 1998;114:51–60
Daud SA, Yusen RD, Meyers BF, et al. Impact of immediate primary lung allograft dysfunction on bronchiolitis obliterans syndrome. Am J Respir Crit Care Med 2007;175:507–13
Whitson BA, Prekker ME, Herrington CS, et al. Primary graft dysfunction and long-term pulmonary function after lung transplantation. J Heart Lung Transplant 2007;26:1004–11
Haider Y, Yonan N, Mogulkoc N, et al. Bronchiolitis obliterans syndrome in single lung transplant recipients – patients with emphysema versus patients with idiopathic pulmonary fibrosis. J Heart Lung Transplant 2002;21:327–33
Tapson VF. ICU stay after single lung transplantation. Chest 1996;110:874–6
Hsu HH, Chen JS, Ko WJ, et al. Short-term outcomes of cadaveric lung transplantation in ventilator-dependent patients. Crit Care 2009;13:R129
Meyers BF, Lynch JP, Trulock EP, et al. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience. J Thorac Cardiovasc Surg 2000; 120:99–107
Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single-lung transplantation for idiopathic pulmonary fibrosis. Ann Intern Med 2009;151:767–74
Whelan TP, Dunitz JM, Kelly RF, et al. Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis. J Heart Lung Transplant 2005;24:1269–74
Neurohr C, Huppmann P, Thum D, et al. Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis. Transplant Int 2010;23:887–96
Elicker BM, Golden JA, Ordovas KG, et al. Progression of native lung fibrosis in lung transplant recipients with idiopathic pulmonary fibrosis. Respir Med 2010;104:426–33
Weiss ES, Jeremiah GA, Merlo CA, et al. Factors indicative of long-term survival after lung transplantation: a review of 836 10-year survivors. J Heart Lung Transplant 2010;29:240–6
Osaki S, Maloney JD, Meyer KC, et al. The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program. Eur J Cardiothorac Surg 2009;36:497–501
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Teo, A., Pietrobon, R., Atashili, J. et al. Short-term outcomes of lung transplant in idiopathic pulmonary fibrosis. Eur Surg 43, 284–294 (2011). https://doi.org/10.1007/s10353-011-0618-6
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DOI: https://doi.org/10.1007/s10353-011-0618-6