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Clinical Features and Outcomes of Combined Pulmonary Fibrosis and Emphysema After Lung Transplantation.
- Source :
-
Chest [Chest] 2021 Nov; Vol. 160 (5), pp. 1743-1750. Date of Electronic Publication: 2021 Jun 26. - Publication Year :
- 2021
-
Abstract
- Background: Combined pulmonary fibrosis and emphysema (CPFE) is recognized as a characteristic syndrome of smoking-related interstitial lung disease that has a worse prognosis than idiopathic pulmonary fibrosis (IPF). However, outcomes after lung transplantation for CPFE have not been reported. The aim of this study is to describe the clinical features and outcomes of CPFE after lung transplantation.<br />Research Question: What are the clinical features and outcomes of CPFE after lung transplantation?<br />Study Design and Methods: This is a single-center retrospective cohort study of patients with CPFE and IPF who underwent lung transplantation at our center between January 2011 and December 2016. We defined CPFE as ≥10% emphysema in the upper lung fields combined with fibrosis on high-resolution CT scan. We characterized the clinical features of patients with CPFE and compared their outcomes after lung transplantation with those with IPF.<br />Results: Twenty-seven of 172 (16%) patients with IPF met criteria for CPFE. Severe pulmonary hypertension was present in 16 of 27 (59%) patients with CPFE. On logistic regression analysis, CPFE was significantly associated with primary graft dysfunction (PGD) grade 3 (OR, 3.14; 95% CI, 1.18-8.37; P = .02). On competing risk regression analysis, CPFE was associated with acute cellular rejection (ACR) grade ≥ A2, and chronic lung allograft dysfunction (CLAD) (hazard ratio [HR], 1.89; 95% CI, 1.10-3.25; P = .02; HR, 1.96; 95% CI, 1.02-3.77; P = .04, respectively). Five-year survival was 79.0% for the CPFE group and 75.4% for the IPF group (log-rank P = .684).<br />Interpretation: After transplantation, patients with CPFE were more likely to develop PGD, ACR, and CLAD compared with those with IPF. However, survival was not significantly different between the two groups.<br /> (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Delayed Graft Function diagnosis
Delayed Graft Function prevention & control
Female
Graft Rejection immunology
Graft Rejection prevention & control
Humans
Hypertension, Pulmonary diagnosis
Hypertension, Pulmonary etiology
Immunosuppression Therapy methods
Immunosuppression Therapy statistics & numerical data
Long Term Adverse Effects diagnosis
Long Term Adverse Effects physiopathology
Lung Transplantation methods
Male
Middle Aged
Respiratory Function Tests methods
Respiratory Function Tests statistics & numerical data
Retrospective Studies
Survival Analysis
Tomography, X-Ray Computed methods
United States epidemiology
Idiopathic Pulmonary Fibrosis diagnosis
Idiopathic Pulmonary Fibrosis mortality
Lung diagnostic imaging
Lung physiopathology
Lung Transplantation adverse effects
Pulmonary Emphysema etiology
Pulmonary Emphysema mortality
Pulmonary Emphysema therapy
Pulmonary Fibrosis etiology
Pulmonary Fibrosis mortality
Pulmonary Fibrosis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 160
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 34186034
- Full Text :
- https://doi.org/10.1016/j.chest.2021.06.036