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Lung transplantation for scleroderma lung disease: An international, multicenter, observational cohort study

Lookup NU author(s): Professor Andrew FisherORCiD

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Abstract

© 2018 International Society for the Heart and Lung Transplantation Background: Due to its multisystemic nature, scleroderma is considered a relative contraindication to lung transplantation at many centers. However, recent studies suggest similar post-transplant outcomes in patients with scleroderma compared to those with other causes of interstitial lung disease (ILD). Furthermore, it remains unknown whether scleroderma-associated pulmonary arterial hypertension (PAH) influences post-transplant outcomes. Our objective in this study was to assess the indications, survival, and prognostic factors of lung or heart–lung transplantation for scleroderma lung disease. Methods: We retrospectively reviewed the data of 90 patients with scleroderma who underwent lung or heart–lung transplantation between 1993 and 2016 at 14 European centers. International criteria were used to diagnose scleroderma. Pulmonary hypertension (PH) was diagnosed during right heart catheterization based on international guidelines. Results: Survival rates after 1, 3, and 5 years were 81%, 68%, and 61%, respectively. By univariate analysis, borderline-significant associations with poorer survival were found for female gender (hazard ratio 2.11; 95% confidence interval [CI] 0.99 to 4.50; p = 0.05) and PAH as the reason for transplantation (hazard ratio 1.90; 95% CI 0.96 to 3.92; p = 0.06). When both these factors were present in combination, the risk of death was 3-fold that in males without PAH. The clinical and histologic presentation resembled veno-occlusive disease in 75% of patients with PAH. Conclusions: Post-transplant survival rates and freedom from chronic lung allograft dysfunction in patients with scleroderma were similar to those in patients with other reasons for lung transplantation. Female sex and PAH in combination was associated with lower survival.

Publication metadata

Author(s): Pradere P, Tudorache I, Magnusson J, Savale L, Brugiere O, Douvry B, Reynaud-Gaubert M, Claustre J, Borgne AL, Holm AM, Schultz HH, Knoop C, Godinas L, Fisher AJ, Hirschi S, Gottlieb J, Le Pavec J

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2018

Volume: 37

Issue: 7

Pages: 903-911

Print publication date: 01/07/2018

Online publication date: 15/03/2018

Acceptance date: 02/04/2016

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier USA

URL: https://doi.org/10.1016/j.healun.2018.03.003

DOI: 10.1016/j.healun.2018.03.003

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