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Supported by the National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis (GNT1116371), and by foundation partner, Boehringer Ingelheim, and program partners, Roche and Galapagos. Rationale : The interstitial lung disease (ILD) multidisciplinary meetings (MDM), composed of pulmonologists, radiologists, and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs, and questions regarding their best practices remain unanswered. Objectives : To achieve consensus among ILD experts on essential components of an ILD MDM. Methods : Using a Delphi methodology, semi-structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0. Results : We interviewed 15 ILD experts, and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high-resolution computed tomography, and a standardized template summarizing collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM, such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs. Conclusions : This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represent an important step toward potential collaborative research into future standardization of ILD MDMs. Postprint

Introduction: Pulmonary hypertension is a malignant prognostic factor in ILD. Prognostic tools are required to help prioritise lung transplant allocation and have not been validated in PH-ILD. We hypothesised that the composite physiological index (CPI) would reliably predict prognosis in PH-ILD, as it reflects both the morphological extent of pulmonary fibrosis and pulmonary vascular disease. Methods: Demographics, ILD subtype, pulmonary function tests, and echocardiograms were collected in consecutive patients undergoing right heart catheterisation (RHC) for suspected PH-ILD. Predictors of prognosis were evaluated in their ability to predict mortality with Cox proportional hazard modelling. Results: 228 ILD patients underwent evaluation between 2005-2015, age 61±11 years, 52% were male, and 79% had PH at RHC. Mean pulmonary pressure (mPAP) in the 168 patients with PH was 37±9.3mmHg, mean pulmonary vascular resistance (PVR) 7.0±3.8 Wood units, mean CPI was 61±13. In the patients with PH-ILD, CPI predicted mortality (Hazard ratio (HR): 1.042, Confidence interval (CI): 1.03-1.06, p Conclusion: The CPI strongly predicts mortality in ILD-PH.