Autoimmune Conditions Not Linked to Worse Lung Transplant Outcomes
People with autoimmune diseases such as sarcoidosis are not at higher risk of worse outcomes following lung or heart-lung transplants compared with people without such diseases, a new single-center study shows.
The findings that autoimmune patients fare as well as others following such transplants refute the long standard approach to withhold lung transplants from these patients due to concerns of post-transplant complications.
“All patients with an autoimmune disease that is causing severe lung damage who would consider lung transplantation should be referred to a transplant center for evaluation,” Jason H. Melehani, MD, PhD, the study’s co-author, said in a press release.
Melehani, a fellow in rheumatology and pulmonology at Stanford Medical Center, presented the results at the virtual ACR Convergence, the American College of Rheumatology’s annual meeting, in the poster, “Overall Survival in Patients with Systemic Autoimmune Diseases Following Lung or Heart-Lung Transplantation at a Single High-Volume Academic Transplant Center: A Comparative Cohort Study.”
Systemic autoimmune diseases are a common cause of irreversible lung damage, which contributes to severe lung disease and early mortality. In most cases, a lung transplant is the only option for these patients, but many transplant centers exclude them from receiving surgery due to concerns regarding their post-transplant outcomes.
In particular, doctors have been concerned that these patients’ overreactive immune systems could cause them to develop post-transplant complications and damage beyond their lungs.
“As a result of their systemic disease and prior immunosuppressive treatments, patients with autoimmune diseases present with unique challenges when undergoing lung transplantation. Studying and addressing these challenges is critical to being able to offer this life-saving intervention to the many patients in need,” Melehani said.
To clarify whether the outcomes of autoimmune disease patients after a lung transplant are that different from those of people without such conditions, researchers at Stanford University in Palo Alto, California, conducted a retrospective analysis of patients who received lung or lung-heart transplants at their center from 2005 through 2019.
Over that period, a total of 75 transplanted patients had systemic autoimmune disorders, including 17 with rheumatoid arthritis, 16 with scleroderma, 15 with sarcoidosis, 14 with idiopathic inflammatory myositis, eight with Sjögren’s syndrome, four with mixed connective tissue disease, and one with systemic lupus erythematosus.
As controls, researchers included a group of 152 patients without autoimmune diseases who also underwent a transplant in the same period. Two controls were matched to each patient according to their age, gender, year of transplant, cause of transplantation (such as interstitial lung disease versus pulmonary hypertension), and type of procedure (single lung, double lung, heart-lung).
The study’s goal was to determine the survival rates of people with and without autoimmune diseases following their transplants. Results showed that 79.4% of those with autoimmune diseases and 90.3% of controls were alive one year after the transplant, and that 54.9% and 57.7% in each group lived at least five years past their transplant.
While further analysis showed a trend toward better survival in the group without autoimmune diseases, the findings failed to reach statistical significance — indicating no significant differences in survival between the groups.
Overall, these findings show that autoimmune disease patients with severe lung disease are not at a higher risk of worse outcomes following a lung or heart-lung transplant.
“This data, along with previous reports from other centers, position lung transplant as an important treatment option even in patients with systemic autoimmune diseases. This study will serve as a starting point for our effort to improve treatment and outcomes for this patient population,” Melehani said.