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Effect of single vs bilateral lung transplantation on plasma surfactant protein D levels in idiopathic pulmonary fibrosis.

ABSTRACT: Serum levels of surfactant protein D (SP-D) have been suggested as reflecting epithelial damage in acute lung injury, COPD, and idiopathic pulmonary fibrosis (IPF). However, little is known about SP-D levels in the setting of lung transplantation.We examined plasma SP-D levels in 104 subjects from a prospective, multicenter cohort study of lung allograft recipients. Plasma SP-D was measured by enzyme-linked immunosorbent assay prior to transplant and daily for 3 days after transplant.Subjects undergoing transplant for IPF had higher baseline SP-D levels (median, 325 ng/mL) compared with subjects with cystic fibrosis, COPD, and pulmonary hypertension (median, 100, 80, and 82 ng/mL, respectively; P = .0001). Among subjects with IPF undergoing bilateral transplant, SP-D levels declined rapidly postoperatively. In contrast, SP-D levels in subjects undergoing single lung transplant for IPF remained significantly higher than those of bilateral allograft recipients. Among subjects undergoing single lung transplant for IPF, the development of primary graft dysfunction (PGD) was associated with a subsequent rise in SP-D levels, whereas SP-D levels in IPF subjects undergoing bilateral transplant declined, even in the presence of grade 3 PGD. Importantly, single lung allograft recipients without PGD had higher postoperative SP-D levels than bilateral allograft recipients with PGD.Subjects undergoing lung transplant for IPF have significantly higher baseline plasma SP-D levels compared with those with other diagnoses. Plasma SP-D is likely a biomarker of the air-blood barrier integrity in the native IPF lung, but may be less useful as a biomarker of PGD after transplant.

SUBMITTER: Sims MW

PROVIDER: S-EPMC3148793 | biostudies-other | 2011 Aug

REPOSITORIES: biostudies-other

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Project description:OBJECTIVE:Lung transplantation remains the only curative treatment for end-stage lung disease, conferring a better survival for some IPF patients, but whether they should receive double lung transplantation (DLT) or single lung transplantation (SLT) is still controversial. The aim of this study was to determine which type of lung transplantation was more effective and relatively safe in IPF patients by meta-analysis. METHODS:Publications comparing overall survival (OS) or other perioperative characteristics between IPF patients undergoing SLT and DLT were selected from electronic databases. The hazard ratios (HRs) were abstracted or calculated to evaluate the survival outcome. Odds ratios (ORs) or mean differences (MDs) were used to compare the causes of death or perioperative parameters. A random-effect model was used to combine data. Heterogeneity was quantified by means of an I2 with 95% confidence interval (95% CI). The publication bias was estimated using the Eggers test with Begg's funnel plots. RESULTS:16 studies with 17,872 IPF cases who met the inclusion criteria were included in this meta-analysis. SLT was associated with declined post-transplant FEV1% (MD = -15.37, 95% CI:-22.28,-8.47; P<0.001), FVC % (MD = -12.52, 95% CI:-19.45,-5.59; P<0.001) and DLCO% (MD = -13.85, 95% CI:-20.42,-7.29; P<0.001), but no significant advantage of DLT over SLT was seen in the overall survival outcome (HR = 1.08, 95% CI: 0.91-1.29; P = 0.391). Subgroup analyses for studies of follow-up period ? 60 months also showed similar results (all P-values>0.05). Moreover, there was fewer deaths attributable to primary graft dysfunction in SLT recipients (OR = 0.31, 95% CI: 0.2-0.48; P<0.001), while more patients with SLT died of malignancy (OR = 3.44, 95% CI: 2.06-5.77; P<0.001). CONCLUSION:Our findings suggest that DLT was associated with better postoperative pulmonary function, but there was no difference in long-term overall survival between patients undergoing DLT and SLT. However, further high-quality and large-scale studies are needed to confirm these findings.

Project description:BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a distinct form of interstitial pneumonia with unknown origin and poor prognosis. Current pharmacologic treatments are limited and lung transplantation is a viable option for appropriate patients. The aim of this review was to summarize lung transplantation survival in IPF patients overall, between single (SLT) vs. bilateral lung transplantation (BLT), pre- and post Lung Allocation Score (LAS), and summarize wait-list survival. METHODS: A systematic review of English-language studies published in Medline or Embase between 1990 and 2013 was performed. Eligible studies were those of observational design reporting survival post-lung transplantation or while on the wait list among IPF patients. RESULTS: Median survival post-transplantation among IPF patients is estimated at 4.5 years. From ISHLT and OPTN data, one year survival ranged from 75% - 81%; 3-year: 59% - 64%; and 5-year: 47% - 53%. Post-transplant survival is lower for IPF vs. other underlying pre-transplant diagnoses. The proportion of IPF patients receiving BLT has steadily increased over the last decade and a half. Unadjusted analyses suggest improved long-term survival for BLT vs. SLT; after adjustment for patient characteristics, the differences tend to disappear. IPF patients account for the largest proportion of patients on the wait list and while wait list time has decreased, the number of transplants for IPF patients has increased over time. OPTN data show that wait list mortality is higher for IPF patients vs. other diagnoses. The proportion of IPF patients who died while awaiting transplantation ranged from 14% to 67%. While later transplant year was associated with increased survival, no significant differences were noted pre vs. post LAS implementation; however a high LAS vs low LAS was associated with decreased one-year survival. CONCLUSIONS: IPF accounts for the largest proportion of patients awaiting lung transplants, and IPF is associated with higher wait-list and post-transplant mortality vs. other diagnoses. Improved BLT vs. SLT survival may be the result of selection bias. Survival pre- vs. post LAS appears to be similar except for IPF patients with high LAS, who have lower survival compared to pre-LAS. Data on post-transplant morbidity outcomes are sparse.

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Effect of single vs bilateral lung transplantation on plasma surfactant protein D levels in idiopathic pulmonary fibrosis.

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