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Lung transplantation for interstitial lung disease: evolution over three decades

Lookup NU author(s): Saskia BosORCiD, Dr James Lordan, Dr Arun Nair, Professor Andrew FisherORCiD, Dr Gerard Meachery



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. BACKGROUND: Interstitial lung disease (ILD) has emerged as the most common indication for lung transplantation globally. However, post-transplant survival varies depending on the underlying disease phenotype and comorbidities. This study aimed to describe the demographics, disease classification, outcomes and factors associated with post-transplant survival in a large single-centre cohort. METHODS: Data were retrospectively assessed for 284 recipients who underwent lung transplantation for ILD in our centre between 1987 and 2020. Patient characteristics and outcomes were stratified by three eras: 1987-2000, 2001-2010 and 2011-2020. RESULTS: Median patients' age at time of transplantation was significantly higher in the most recent decade (56 (51-61) years, p<0.0001). Recipients aged over 50 years had worse overall survival compared with younger patients (adjusted HR, aHR 2.36, 95% CI 1.55 to 3.72, p=0.0001). Better survival was seen with bilateral versus single lung transplantation in patients younger than 50 years (log-rank p=0.0195). However, this survival benefit was no longer present in patients aged over 50 years. Reduced survival was observed in fibrotic non-specific interstitial pneumonia compared with idiopathic pulmonary fibrosis, which remained the most common indication throughout (aHR 2.61, 95% CI 1.40 to 4.60, p=0.0015). CONCLUSION: In patients transplanted for end-stage ILD, older age and fibrotic non-specific interstitial pneumonia were associated with poorer post-transplant survival. The benefit of bilateral over single lung transplantation diminished with increasing age, suggesting that single lung transplantation might still be a feasible option in older candidates.

Publication metadata

Author(s): Leong SW, Bos S, Lordan JL, Nair A, Fisher AJ, Meachery G

Publication type: Article

Publication status: Published

Journal: BMJ Open Respiratory Research

Year: 2023

Volume: 10

Issue: 1

Online publication date: 28/02/2023

Acceptance date: 14/12/2022

Date deposited: 13/03/2023

ISSN (electronic): 2052-4439

Publisher: BMJ Publishing Group


DOI: 10.1136/bmjresp-2022-001387

PubMed id: 36854571


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