Factors associated with listing for lung transplantation in IPF patients: An analysis of the pulmonary fibrosis foundation registry

Christopher S King; Emily White; Shambhu Aryal; Oksana A Shlobin; Anju Singhal; A Whitney Brown; Christopher Thomas; Vikramjit Khangoora; Alan Nyquist; Kevin R Flaherty; Steven D Nathan; Joshua J Mooney

doi:10.1016/j.heliyon.2023.e18618

Factors associated with listing for lung transplantation in IPF patients: An analysis of the pulmonary fibrosis foundation registry

Heliyon. 2023 Aug 5;9(8):e18618. doi: 10.1016/j.heliyon.2023.e18618. eCollection 2023 Aug.

Affiliations

¹ Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA.
² University of Michigan, Department of Biostatistics, USA.
³ University of Michigan Division of Pulmonary & Critical Care Medicine, USA.
⁴ Stanford University, Division of Pulmonary and Critical Care Medicine, USA.

Abstract

Rationale and objectives: Lung transplantation is a potentially life-saving treatment option for patients with idiopathic pulmonary fibrosis (IPF); however, not all eligible candidates get referred and listed for transplantation. Amongst IPF patients within the Pulmonary Fibrosis Foundation Patient Registry (PFF-R), we sought to determine the proportion of patients who undergo lung transplant listing and the characteristics associated with transplant listing.

Methods: An analysis of IPF patients with at least six months of follow-up data was performed. Patients with well-established contraindications to lung transplantation were excluded. Two complementary analyses were performed. The "prevalent" population included all patients with IPF at time of enrollment into the registry. The "incident severe" population included all patients with IPF who progressed to GAP Stage 3.

Results: Of the 2003 patients in the PFF-R, 475 patients were included in the "prevalent" population. Of this group, only 42 (8.8%) were either listed for or underwent lung transplant. Univariable analysis of the "prevalent" population found age (per 10 year increase, OR 0.531, p = 0.0025), percent predicted FVC (OR 0.572, p=<0.0001), percent predicted DLCO (OR 0.606, p < 0.0001), 6-min walk distance (per 50 m, OR 0.831, p = 0.019), and oxygen use at rest (OR 5.157, p < 0.0001) were predictive of listing. On multivariable analysis, age (per 10 year increase, OR 0.558, p = 0.0088), percent predicted FVC (OR 0.728, p = 0.0161), and oxygen use at rest (OR 3.264, p = 0.0029) remained significant predictors for lung transplant listing. The "incident severe" group consisted of 176 patients (8.8%). 24 patients (13.6%) from this cohort were either listed for or received a transplant. Only age (per 10 year increase, OR 0.0286, p = 0.0465) was associated with transplant listing on univariable analysis in the Incident severe population.

Conclusion: Only a small proportion of potentially eligible patients with IPF are listed for lung transplantation, even when seen at pulmonary fibrosis centers of excellence. Advanced age appears to be the primary factor associated with failure to be listed. Further refinement of future registry data is required to more clearly delineate exact reasons for low rates of listing.

Keywords: Idiopathic pulmonary fibrosis; Lung transplantation; Pulmonary fibrosis.