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Lung Transplant Outcomes in Systemic Sclerosis with Significant Esophageal Dysfunction. A Comprehensive Single-Center Experience.

Authors :
Miele, Catherine H.
Schwab, Kristin
Saggar, Rajeev
Duffy, Erin
Elashoff, David
Tseng, Chi-Hong
Weigt, Sam
Charan, Deepshikha
Abtin, Fereidoun
Johannes, Jimmy
Derhovanessian, Ariss
Conklin, Jeffrey
Ghassemi, Kevin
Khanna, Dinesh
Siddiqui, Osama
Ardehali, Abbas
Hunter, Curtis
Kwon, Murray
Biniwale, Reshma
Lo, Michelle
Source :
Annals of the American Thoracic Society; Jun2016, Vol. 13 Issue 6, p793-802, 10p
Publication Year :
2016

Abstract

<bold>Rationale: </bold>Consideration of lung transplantation in patients with systemic sclerosis (SSc) remains guarded, often due to the concern for esophageal dysfunction and the associated potential for allograft injury and suboptimal post-lung transplantation outcomes.<bold>Objectives: </bold>The purpose of this study was to systematically report our single-center experience regarding lung transplantation in the setting of SSc, with a particular focus on esophageal dysfunction.<bold>Methods: </bold>We retrospectively reviewed all lung transplants at our center from January 1, 2000 through August 31, 2012 (n = 562), comparing the SSc group (n = 35) to the following lung transplant diagnostic subsets: all non-SSc (n = 527), non-SSc diffuse fibrotic lung disease (n = 264), and a non-SSc matched group (n = 109). We evaluated post-lung transplant outcomes, including survival, primary graft dysfunction, acute rejection, bronchiolitis obliterans syndrome, and microbiology of respiratory isolates. In addition, we defined severe esophageal dysfunction using esophageal manometry and esophageal morphometry criteria on the basis of chest computed tomography images. For patients with SSc referred for lung transplant but subsequently denied (n = 36), we queried the reason(s) for denial with respect to the concern for esophageal dysfunction.<bold>Measurements and Main Results: </bold>The 1-, 3-, and 5-year post-lung transplant survival for SSc was 94, 77, and 70%, respectively, and similar to the other groups. The remaining post-lung transplant outcomes evaluated were also similar between SSc and the other groups. Approximately 60% of the SSc group had severe esophageal dysfunction. Pre-lung transplant chest computed tomography imaging demonstrated significantly abnormal esophageal morphometry for SSc when compared with the matched group. Importantly, esophageal dysfunction was the sole reason for lung transplant denial in a single case.<bold>Conclusions: </bold>Relative to other lung transplant indications, our SSc group experienced comparable survival, primary graft dysfunction, acute rejection, bronchiolitis obliterans syndrome, and microbiology of respiratory isolates, despite the high prevalence of severe esophageal dysfunction. Esophageal dysfunction rarely precluded active listing for lung transplantation. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
23296933
Volume :
13
Issue :
6
Database :
Complementary Index
Journal :
Annals of the American Thoracic Society
Publication Type :
Academic Journal
Accession number :
116156054
Full Text :
https://doi.org/10.1513/AnnalsATS.201512-806OC