Considerations for Lung Transplants in Patients with SARD-ILD

Dr. Danoff noted that in recent years, median survival times after lung transplant have not improved as much for ILD patients as they have for some other indications for lung transplant. A 2023 analysis from the International Society for Heart and Lung Transplantation showed that the median survival time after lung transplantation from all indications is around six years, but for SARD-ILD this may be closer to five.^6,7

“In lung transplantation we have made strides in the right direction regarding survival, but only modest strides for patients with ILD. The lung is a very tough organ [to transplant],” Dr. Danoff added.

The Johns Hopkins data indicate that most of the SARD-ILD patients survived for at least three years post-transplant, but differences in survival rates among different specific SARDs appeared after that. SARD-ILD patients with myositis tended to do the worst, a finding that has been reflected in at least one other international study.⁸

“Lung transplant is clearly a last resort for our patients with advanced ILD-CTD,” said Dr. Danoff. “I don’t say this because I think that there’s no reason to transplant patients, but I think that we have to have a realistic understanding of what we’re offering.”

Ruth Jessen Hickman, MD, a graduate of the Indiana University School of Medicine, is a medical and science writer in Bloomington, Ind.

References

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2. Weill D. Lung transplantation: Indications and contraindications. J Thorac Dis. 2018 Jul;10(7):4574–4587.
3. Rajagopala S, Jindal A. Lung transplantation in connective tissue disease associated interstitial lung disease. Indian J Rheumatol. 2021 Dec;16:S101–S108.
4. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2021 Nov;40(11):1349–1379.
5. Zhang N, Liu S, Zhang Z. Lung transplantation: A viable option for connective tissue disease?Arthritis Care Res (Hoboken). 2023 Nov;75(11):2389–2398. 
6. Singh TP, Cherikh WS, Hsich E, et al. Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2023 Oct;42(10):1321–1333.
7. Prieto-Peña D, Martínez-Meñaca A, Calderón-Goercke M, et al. Long-term survival of lung transplantation for interstitial lung disease associated with connective tissue diseases: A study of 26 cases from a referral centre. Clin Exp Rheumatol. 2020 Jul-Aug;38(4):615–620.
8. Yang X, Wei D, Liu M, et al. Survival and outcomes after lung transplantation for connective tissue disease-associated interstitial lung diseases. Clin Rheumatol. 2021 Sep;40(9):3789–3795.