Dataset Information

Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers.

ABSTRACT: Lung transplantation in patients with systemic sclerosis (SSc) can be complicated by extrapulmonary manifestations of the disease, leading to concerns regarding posttransplant complications and outcomes.

Methods

We conducted a web-based survey of adult lung transplant programs in the United States regarding their practices in patients with SSc.

Results

Sixty percent (37/62) of the eligible centers responded to the survey, majority of the respondents were medical directors (81%). Most centers would consider transplanting patients with mild or moderate esophageal disease (92% or 75%, respectively) or gastroparesis (59%). A minority would consider patients with severe esophageal dysmotility (37%), digital ulcers (21%), or low body mass index (19%). Most centers conducted extensive pretransplant gastrointestinal evaluation and use a conservative feeding approach with prolonged nothing by mouth (83%) and postpyloric feeding (89%). Antireflux surgery is commonly considered (40%) with partial fundoplication being the procedure of choice (67%). Most respondents expected similar outcomes of acute or chronic rejection (81% and 51%, respectively), respiratory infections (76%), and 1-year survival (70%).

Conclusions

Most US lung transplant centers do not universally exclude SSc from lung transplant listing, but most support extensive pretransplant gastrointestinal testing and a conservative approach to feeding in the early posttransplant period.

SUBMITTER: Sehgal S

PROVIDER: S-EPMC8425834 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers.

Sehgal Sameep S Pennington Kelly M KM Zhao Huaqing H Kennedy Cassie C CC

Transplantation direct 20210907 10

Lung transplantation in patients with systemic sclerosis (SSc) can be complicated by extrapulmonary manifestations of the disease, leading to concerns regarding posttransplant complications and outcomes.<h4>Methods</h4>We conducted a web-based survey of adult lung transplant programs in the United States regarding their practices in patients with SSc.<h4>Results</h4>Sixty percent (37/62) of the eligible centers responded to the survey, majority of the respondents were medical directors (81%). Mo ...[more]

PMID: 34514112

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Project description:BackgroundSimultaneous lung-kidney transplantation is rarely performed. Contemporary national practice trends and outcomes are unclear.MethodsFrom the United Network for Organ Sharing database, we identified 108 lung-kidney transplant recipients (2005-2022). They were compared with isolated lung recipients with pretransplantation dialysis or estimated glomerular filtration rate (eGFR) ≤30 mL/min per 1.73 m2 (n = 372) and isolated non-dialysis-dependent lung recipients with 30 < eGFR < 50 mL/min per 1.73 m2 (n = 1416), respectively. Lung-kidney recipients were also compared with recipients of the contralateral kidney from the same donors (n = 90).ResultsLung-kidney transplantation was performed by 36 centers, with increasing annual volume (1 in 2005, 16 in 2022; P < .01). Forty percent (44/108) of lung-kidney recipients received pretransplantation dialysis, and of those without pretransplantation dialysis, median eGFR was 30.7 mL/min per 1.73 m2. Lung-kidney recipients had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m2 or pretransplantation dialysis (adjusted hazard ratio, 0.59; 95% CI, 0.38-0.92). However, no survival benefit was observed when lung-kidney recipients were compared with isolated lung recipients with 30 < eGFR < 50 mL/min per 1.73 m2 and no pretransplantation dialysis (adjusted hazard ratio, 0.88; 95% CI, 0.55-1.41). Compared with isolated kidney recipients using the contralateral kidney from the same donors, lung-kidney recipients had a higher risk of kidney allograft loss (adjusted hazard ratio, 3.27; 95% CI, 1.22-8.78), a difference largely accounted for by patient death with a functioning kidney allograft.ConclusionsRecipients of lung-kidney transplants had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m2 or pretransplantation dialysis. However, lung-kidney recipients had a higher rate of kidney allograft loss than recipients of the contralateral kidney allograft from the same donors.

Dataset Information

Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers.

Methods

Results

Conclusions

Publications

Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers.

Similar Datasets

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