A survey of referral rates for lung transplant assessment in patients with interstitial lung disease meeting pulmonary function criteria

Abstract

<b>Background:</b> Interstitial lung diseases (ILD) unresponsive to medical therapy often require lung transplantation (LT), which prolongs quality-of-life and survival. Ideal timing for referral for LT remains challenging, with late-referral associated with significant morbidity and mortality. Among other criteria, ILD patients should be considered for LT if FVC is less than 80% or DLCO is less than 40%. Data on referral rates are lacking. Our objective was to evaluate referral rates and identify barriers associated with non-referral. <b>Methods:</b> A single-center, retrospective cohort study of ILD patients performed pulmonary function test (PFT) between 2014 and 2020. Patients with FVC&lt;80% or a DLCO&lt;40% were included in the study. Patients with absolute contraindications to LT were excluded. Referral rates were computed, and a comparison was made between referred and non-referred subjects. <b>Results:</b> Out of 114 ILD patients meeting PFT criteria for referral to LT, only 35 were referred (30.7%), and 7 undergone LT. Median time from PFT to referral for assessment was 255 days [IQR 35-1077]. Median time from referral to LT was 89 days [IQR 59-143]. Referred patients were younger [P=0.003], had lower FVC [P&lt;0.001], DLCO [P&lt;0.001], and a higher rate of pulmonary hypertension [P=0.04]. Lower FVC was associated with mortality [HR=0.96, CI 0.95-0.98 P=0.001]. There was no difference in mortality between the groups. <b>Conclusions:</b> There appears to be under-referral of ILD patients eligible for LT. Late referral is associated with severe disease, higher mortality rates and often miss the window of opportunity for LT. Further study is needed to validate our findings.