Systemic autoimmune disease does not affect overall survival in lung transplant
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Data presented at ACR Convergence 2021 support the use of life-saving lung transplantation among qualified patients with systemic autoimmune diseases.
Specifically, results of the retrospective study showed that patients with systemic disease did as well as those without systemic causes of end-stage lung disease after transplantation.
“Patients with systemic autoimmune diseases commonly have lung manifestations, and that can range from anything from interstitial lung disease to pulmonary arterial hypertension, both of which are extremely consequential for their quality of life and their length of life,” Jason H. Melehani, MD, PhD, a fellow in rheumatology and pulmonology at Stanford University, said during a press conference. “Numerous studies have identified lung involvement as one of the most significant contributors to early mortality in these populations.”
He added that “there are currently no treatments that reverse lung disease or improve lung health-related quality of life measures. For patients with progressive lung involvement who reach end-stage lung disease, lung transplant may be an appropriate option to extend and improve their quality of life.”
However, as Melehani explained, there are unique challenges to transplantation in patients with systemic autoimmune disease, including risk for organ rejection, risk for post-transplant infections and possible complications to post-surgical and post-transplant recovery.
To better understand the risks among these patients, Melehani and colleagues collected data for patients who underwent lung or heart-lung transplantation between Jan. 1, 2005, and Jan. 1, 2020, at Stanford University. Patients with lung disease associated with a systemic autoimmune disease were matched 1:2 with controls without autoimmune disease based on age, gender, year of transplantation, reason for transplantation (interstitial lung disease vs. pulmonary hypertension) and type of procedure (single lung, double lung or heart-lung).
The researchers compared overall survival among patients with and without autoimmune diseases. They also estimated HRs and 95% CIs for overall survival after transplantation.
Seventy-five transplant patients with systemic autoimmune disease were identified and matched with 152 transplant patients without autoimmune disease. Among patients with autoimmune disease, 1-year survival rate was 79.4% and 5-year survival rate was 54.9% compared with rates in patients without autoimmune disease: 90.3% for 1 year and 57.7% for 5 year (P = .16).
Though patients without autoimmune diseases had a more favorable HR for overall survival following transplantation, there was not a significant difference among those with autoimmune diseases (unadjusted HR = 1.29; 95% CI, .80-2.08; adjusted HR = 1.24; 95% CI, .71-2.18).
“We have planned exploratory analyses to examine pre-transplant physiologic variables and indicators of disease severity to try to better understand important factors in patient selection pre-transplant preparation and post-transplant care,” Melehani said. “Overall, our study adds to published experience from a variety of other centers across the United States and Europe that further support that lung transplant should be an option available to carefully selected patients with systemic autoimmune diseases.”
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Melehani JH. Abstract 1385. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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