Lung Transplant Outcomes for Idiopathic Pulmonary Fibrosis: Are We Improving?

Abstract

Following implementation of the Lung Allocation Score in 2005, idiopathic pulmonary fibrosis (IPF) emerged as the most common indication for lung transplant (LT) in the United States. The age and comorbidity of patients receiving LT have since increased and the indications for LT have evolved. However, limited data have analyzed more recent outcomes among the IPF population. We analyzed LTs for the primary indication of IPF using the United Network for Organ Sharing database. We performed an eras-based analysis, comparing patient characteristics, survival, and related outcomes during 2005-2009 (Era 1) and 2010-2014 (Era 2) with Chi square, Wilcoxon rank sum, and Kaplan-Meier analyses. We compared 1-year survival from 2005-2020 and survival at milestones ranging from 1-month to 5-years. We conducted two adjusted Cox proportional hazards models: 5-year survival by era and 1-year survival annually from 2010-2020. From Era 1 (n=1818) to Era 2 (n=3227), the median age of LT recipients increased from 61 to 63 years old (p<0.001). Patients in the intensive care unit prior to LT climbed from 7.7% to 12.1% (p<0.001), and patients with diabetes grew from 17.9% to 19.4% (p=0.003). Despite increased severity of illness, 5-year survival increased from 51.9% in Era 1 to 55.2% in Era 2 (p=0.02). Adjusted modeling indicated that LT during Era 2 featured a 17% hazard reduction compared to Era 1 (Hazard Ratio = 0.83, 95% CI: 0.76-0.91). Survival is improving for patients undergoing LT for IPF, despite the challenges of transplantation patients with progressively higher risk profiles.