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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2003;126:469-475
© 2003 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis

Gabriel Thabut, MDa,*, Hervé Mal, MDa, Yves Castier, MDb, Odile Groussard, MDc, Olivier Brugière, MDa, Rolana Marrash-Chahla, MDa, Guy Lesèche, MDb, Michel Fournier, MDa

a Service de Pneumologie et Réanimation Respiratoire, Clichy, France
b Service de Chirurgie Thoracique et Vasculaire, Clichy, France
c Service d’Anatomopathologie, Hôpital Beaujon, Clichy, France

Received for publication July 22, 2002. Received for publication July 22, 2002; revisions received August 22, 2002; revisions received November 22, 2002; accepted for publication December 4, 2002.

* Address for reprints: Gabriel Thabut, MD, Service de Pneumologie et Réanimation, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110, Clichy, France
gabriel.thabut{at}bjn.ap-hop-paris.fr

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.

Key Words: 12






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