Idiopathic Pulmonary Fibrosis and Lung Transplantation: When it is Feasible.
Elisabetta BalestroElisabetta CocconcelliMariaenrica TinèDavide BiondiniEleonora FaccioliMarina SaettaFederico ReaPublished in: Medicina (Kaunas, Lithuania) (2019)
Despite the availability of antifibrotic therapies, many patients with idiopathic pulmonary fibrosis (IPF) will progress to advanced disease and require lung transplantation. International guidelines for transplant referral and listing of patients with interstitial lung disease are not specific to those with IPF and were published before the widespread use of antifibrotic therapy. In this review, we discussed difficulties in decision-making when dealing with patients with IPF due to the wide variability in clinical course and life expectancy, as well as the acute deterioration associated with exacerbations. Indeed, the ideal timing for referral and listing for lung transplant remains challenging, and the acute deterioration might be influenced after transplant outcomes. Of note, patients with IPF are frequently affected by multimorbidity, thus a screening program for occurring conditions, such as coronary artery disease and pulmonary hypertension, before lung transplant listing is crucial to candidate selection, risk stratification, and optimal outcomes. Among several comorbidities, it is of extreme importance to highlight that the prevalence of lung cancer is increased amongst patients affected by IPF; therefore, candidates' surveillance is critical to avoid organ allocation to unsuitable patients. For all these reasons, early referral and close longitudinal follow-up for potential lung transplant candidates are widely encouraged.
Keyphrases
- idiopathic pulmonary fibrosis
- interstitial lung disease
- end stage renal disease
- coronary artery disease
- pulmonary hypertension
- newly diagnosed
- ejection fraction
- chronic kidney disease
- primary care
- liver failure
- rheumatoid arthritis
- decision making
- systemic sclerosis
- risk factors
- prognostic factors
- peritoneal dialysis
- randomized controlled trial
- chronic obstructive pulmonary disease
- public health
- stem cells
- pulmonary arterial hypertension
- cystic fibrosis
- heart failure
- metabolic syndrome
- risk assessment
- aortic valve
- mesenchymal stem cells
- cross sectional
- hepatitis b virus
- cell therapy
- percutaneous coronary intervention
- aortic dissection
- left ventricular
- drug induced
- transcatheter aortic valve replacement
- insulin resistance