Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation

Abstract

Objective: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. Results: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. Conclusions: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF.

What is expected in lung function after lung transplantation due to end‐stage pulmonary silicosis?

“…In addition, they demonstrated that elevated pre‐LTx mean pulmonary artery pressure returned to normal value post‐LTx . We observed similar findings in our study, with PFT values 1 month after LTx surgery of FVC 2.22 ± 1.16 L (52.38% ± 27.72%), FEV 1 1.85 ± 0.97 L (54.56% ± 29.4%), TLC 3.43 ± 1.74 L, and RV 1.23 ± 0.6 L, and continuous improvement throughout the first year of follow‐up: FVC 3.08 ± 1.58 L (65.88% ± 34.47%), FEV 1 2.14 ± 1.13 L (71.20% ± 37.64%), which is similar to findings among IPF patients after LTx …”

“…Survival for patients with silicosis at 6 months, and at 1 and 3 years post‐LTx were 86%, 86%, and 76%, respectively . In contrast, the survival rates we observed in our LTx group at 1, 3, and 5 years post‐LTx were 69%, 44%, and 25%, respectively, similar to a recent report on IPF patients undergoing single LTx at ISCMPA (first‐year survival, 70%) …”

“…A previous data report by our group reviewed the PFTs of 44 patients with idiopathic pulmonary fibrosis (IPF), a similar structural disease, before and after LTx. Pre‐LTx values were FEV 1 1.48 ± 0.48 L (52% ± 17% of predicted values), FVC 1.78 ± 0.60 L (50% ± 18% of predicted values), and FEV 1 /FVC 83±19, and all patients showed a marked improvement post‐LTx …”

“…30 In contrast, the survival rates we observed in our LTx group at 1, 3, and 5 years post-LTx were 69%, 44%, and 25%, respectively, similar to a recent report on IPF patients undergoing single LTx at ISCMPA (first-year survival, 70%). 28 We speculated that the poor pre-operative status, as well as factors like the particularities of a developing country and the scarcity of resources like extracorporeal membrane oxygenation support, may have influenced our outcomes. We also recognize that our study has limitations as it is a single institution retrospective analysis, and although there was a significant number of patients with silicosis on the wait list for LTx, it remains a limited cohort.…”

Single versus double lung transplantation for fibrotic disease—systematic review

“…Out of the seven studies that present survival rates of BLTx The other studies align with the findings of the UNOS Registry and ISHLT registry, which outline that BLTx has improved survival for IPF patients over SLTx (14)(15)(16)(17)(18)(19)(20)(21)(22). In their cohort of 469 patients, 82 of which had IPF, Mason et al found that patients receiving BLTx had better riskunadjusted survival than those receiving SLTx, with 1-year survival at 81% and 67%, and 5-year survival at 55% and 34%, respectively.…”