COUNTERPOINT: Should Every Patient With Idiopathic Pulmonary Fibrosis Be Referred for Transplant Evaluation? No

Glanville, Allan R.

doi:10.1016/j.chest.2019.12.031

Cited by 5 publications

(4 citation statements)

References 10 publications

(8 reference statements)

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“…The ISHLT document is straightforward, but the opinions of ILD specialists on which and when IPF patients should be transferred differ [ 4 ]. Although patients have the right to be informed about all treatment options, a very strong argument about the feasibility of such an approach in a very common scenario of limited resources speaks against this practice [ 9 , 10 ]. Discrepancies between guidelines and clinical practice were shown in the study of Swaminathan et al, who reported that 30.4% of IPF patients in the IPF-PRO registry were eligible for lung transplantation (age criterion < 70 years).…”

Section: Discussionmentioning

confidence: 99%

Adherence to the ISHLT Protocol for the Referral of Patients with Idiopathic Pulmonary Fibrosis to the Transplantation Center among of Czech Centers for Interstitial Lung Diseases

Sterclova,

Doubkova,

Sykorova

et al. 2024

Pulmonary Medicine

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There are limited data on referral rates and the number of patients with idiopathic pulmonary fibrosis (IPF) who are eligible for lung transplantation. The aim of the present study was to assess adherence to the consensus of the International Society for Heart and Lung Transplantation (ISHLT) for the referral of patients with IPF among Czech interstitial lung disease (ILD) centers. Czech patients who were diagnosed with IPF between 1999 and 2021 (n = 1584) and who were less than 65 years old at the time of diagnosis were retrospectively selected from the Czech Republic of the European Multipartner Idiopathic Pulmonary Fibrosis Registry (EMPIRE). Nonsmokers and ex‐smokers with a body mass index (BMI) of <32 kg/m2 (n = 404) were included for further analyses. Patients with a history of cancer <5 years from the time of IPF diagnosis, patients with alcohol abuse, and patients with an accumulation of vascular comorbidities were excluded. The trajectory of individual patients was verified at the relevant ILD center. From the database of transplant patients (1999‐12/2021, n = 541), all patients who underwent transplantation for pulmonary fibrosis (n = 186) were selected, and the diagnosis of IPF was subsequently verified from the patient’s medical records (n = 67). A total of 304 IPF patients were eligible for lung transplantation. Ninety‐six patients were referred to the transplant center, 50% (n = 49) of whom were referred for lung transplantation. Thirty percent of potentially eligible patients not referred to the transplant center were considered to have too many comorbidities by the reporting physician, 19% of IPF patients denied lung transplantation, and 17% were not referred due to age. Among Czech patients with IPF, there may be a larger pool of potential lung transplant candidates than has been reported to the transplant center to date.

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Section: Discussionmentioning

confidence: 99%

Adherence to the ISHLT Protocol for the Referral of Patients with Idiopathic Pulmonary Fibrosis to the Transplantation Center among of Czech Centers for Interstitial Lung Diseases

Sterclova,

Doubkova,

Sykorova

et al. 2024

Pulmonary Medicine

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“…IPF patients are usually the most critical patients on the transplant list with the highest death rate, that is why early referral for transplant evaluation should be done even before assessing response to initial medical treatment [ 54 ]. IPF patients should be referred for transplantation if they meet the following criteria [ 55 ] including dyspnea or functional disability related to lung disease and desaturating below 89% at rest or exertion.…”

Section: Reviewmentioning

confidence: 99%

Treatment of Idiopathic Pulmonary Fibrosis

Abuserewa¹,

Duff

Becker

2021

Cureus

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia of unknown cause, occurring in adults and limited to the lungs. In the past, treatment was aimed at minimizing inflammation and slowing the progression of inflammation to fibrosis. However, the underlying lesion in IPF may be more fibrotic than inflammatory, explaining why few patients respond to anti-inflammatory therapies and the prognosis remains poor.In this review of literature, we will be focusing on main lines of treatment including current medications, supportive care, lung transplantation evaluation, and potential future strategies of treatment.

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“…1 When one compares our two arguments there are, in truth, a large number of commonalities. 1,2 In short, we both agree that early referral has significant and tangible as well as intangible benefits both for the caring team and the patient, and these are well discussed. Where we appear to differ, however, is in the details of a practical and sensible resource use strategy.…”

mentioning

confidence: 90%