ISHLT consensus document on lung transplantation in patients with connective tissue disease: Part I: Epidemiology, assessment of extrapulmonary conditions, candidate evaluation, selection criteria, and pathology statements

Crespo, Maria; Lease, Erika D.; Solé, Amparó; Sandorfi, Nora; Snyder, Laurie D.; Berry, Gerald J.; Pavec, Jérôme Le; Venado, Aida; Cifrián, José; Goldberg, Hilary J.; Dilling, Daniel F.; Gries, Cynthia J.; Nair, Arun; Willie, Keith; Meyer, Keith C.; Shah, Rupal J.; Tokman, Sofya; Holm, Are Martin; Patterson, Caroline; McWilliams, Tanya; Shtraichman, Osnat; Bemiss, B.; Salgado, Juan Carlos; Farver, Carol; Strah, Heather; Wassilew, Katharina; Kaza, Vaidehi; Howsare, Molly; Murray, Michelle; Bhorade, Sangeeta; Budev, Marie

doi:10.1016/j.healun.2021.07.014

Cited by 20 publications

(13 citation statements)

References 109 publications

(101 reference statements)

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“…Patients with autoimmune CTD and advanced pulmonary involvement can be considered suboptimal candidates for lung transplant due to their underlying medical complexity and potential surgical risk. Nevertheless, the International Society of Heart and Lung Transplantation (ISHL) consensus document suggests that patients with autoimmune CTD can be acceptable candidates if there are no extrapulmonary manifestations (20). Nevertheless, a lung transplant is not so frequent in a patient with an acute manifestation of ILD and without any chronic lung disease (21).…”

Section: Discussionmentioning

confidence: 99%

Urgent lung transplant in acute pulmonary scleroderma: a case report

Benedetto¹,

Piccone²,

Dolci³

et al. 2022

Shanghai Chest

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Background: Systemic scleroderma (SSc) is an autoimmune disease that may dramatically affect the lungs.Previous case reports have shown successful results in patients with a chronic autoimmune disease listed for bilateral lung transplantation. This paper reports similar results in a patient with SSc with acute onset of lung failure requiring an awake veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a bridge to lung transplant.Case Description: A 43-year-old male patient with no comorbidities presented with a 6-month history of arthralgia and weakness and was diagnosed with SSc. Within a month he developed a severe acute respiratory failure refractory to conventional therapy, and he was referred to our unit for a V-V ECMO placement.There was no significant lung function improvement and, 2 weeks after the initiation of V-V ECMO, the patient underwent an urgent bilateral lung transplant. The patient was successfully discharged home 3 months later. No evidence of pulmonary scleroderma relapse was found at 1-and 3-month follow up.Conclusions: This report supports the practice of V-V ECMO and urgent lung transplant as a life-saving option in patients with an autoimmune disease and rapid interstitial lung disease (ILD) which led to endstage respiratory failure.

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Section: Discussionmentioning

confidence: 99%

Urgent lung transplant in acute pulmonary scleroderma: a case report

Benedetto¹,

Piccone²,

Dolci³

et al. 2022

Shanghai Chest

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“…The willingness to accept any risk may vary between centers, depending on local expertise and the local need to ration the limited organ supply. The ISHLT CTD consensus lists the absolute contraindication for LTx based on a Delphi voting method agreement when at least 80% of workforce members voted 8 or higher [3 ▪▪ ]. These absolute contraindications are summarized in Table 1.…”

Section: Candidate Selectionmentioning

confidence: 99%

“…Also, gastrointestinal evaluation and posttransplant management of esophageal dysmotility variability, particularly nil per os (NPO) and duration and preemptive post-LTx feeding strategies. This review will discuss the recently published International Society for Heart and Lung Transplantation (ISHLT) consensus document recommendations in the evaluation, selection, and post-LTx management of CTD candidates, and highlight the importance of standardized selection of CTD candidates to facilitate successful outcomes [3 ▪▪ –5 ▪▪ ]…”

Section: Introductionmentioning

confidence: 99%

Managing connective tissue disease: how to select and facilitate successful transplantation

Bermúdez¹,

Crespo

2022

Current Opinion in Organ Transplantation

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Purpose of reviewLung transplant (LTx) evaluation and selection of candidates with connective tissue disease (CTD) remains controversial and varies between centers, and the optimal candidate selection is still controversial.Recent findingsRecent United States and European publications have reported reasonable short-term and long-term LTx outcomes in patients with CTD to other lung fibrosis patients without CTD. This article discusses the recently published International Society for Heart and Lung Transplantation (ISHLT) consensus document recommendations to evaluate and select CTD candidates, the importance of early referral, posttransplant management, and the involvement of a multidisciplinary team.SummaryFuture standardized practices among centers adapting the 2021 ISHLT consensus recommendations to evaluate and select CTD candidates will allow risk stratification, determine the best candidates, and facilitate the most successful long-term LTx outcomes.

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“…This represents a group of otherwise good potential LTx candidates in terms of physical fitness and motivation, and previous studies have demonstrated that appropriately screened and carefully selected individuals have no difference in outcomes or allograft function (5,6). It is clear that LTx for CTD-ILD remains controversial given the recently published ISHLT data which highlighted that only 0.9% of LTx performed were related to CTD-ILD (3). The potential reasons for such low numbers are multifactorial and include concerns over survival and clinical outcomes, and the impact of extrapulmonary manifestations on the transplanted lungs.…”

mentioning

confidence: 99%

“…In patients with connective tissue diseases (CTDs), pulmonary involvement in the form of either interstitial lung disease (ILD) or pulmonary hypertension (PH) remains a significant cause of morbidity and mortality (2). In view of the multisystem nature of CTDs, with concurrent gastrointestinal, cardiac and renal involvement, CTD-associated ILD (CTD-ILD) remains a relative contraindication for LTx as per recent International Society for Heart and Lung Transplantation (ISHLT) guidelines (3,4). This includes SSc, which is a multisystem autoimmune condition that primarily affects the young female population.…”

mentioning

confidence: 99%