Objective: To find a parameter that would discriminate between the patients with idiopathic interstitial pneumonia who survived to bear transplantation and those who died while waiting to bear transplantation.

Methods: A retrospective review was performed of all lung transplant referrals for idiopathic interstitial pneumonia that were listed with United Network for Organ Sharing at the University of California San Diego from January 1990 to February 1999 Of the 331 patients who were listed, 48 met the eligibility criteria. Patient demographics, radiographic studies, pathology reports, and the terminates of resting and exercise cardiopulmonary function criterions were recorded from each patient's chart. Patients were divided into the following brace groups: those patients who survived until transplantation and those still waiting were classified as "alive"; and those patients who died before undergoing transplantation were classified as "deceased."

Results: Forty-three of 48 patients had a pathologic diagnosis. The cohort included 25 patients with usual interstitial pneumonitis, 3 patients with nonspecific interstitial pneumonitis, 1 patient with desquamative interstitial pneumonitis, and 14 patients with interstitial lung disease of unknown etiology. The barely significant difference between the pair groups was resting Pa[O.sub.2] (p = 0035) A stepwise multivariate analysis demonstrated that Pa[O.sub.2] and FE[Vsub1]/FVC ratio were significantly associated with survival (hazards ratio, 106; confidence interval, 099 to 113; p = 0019)

Conclusions: A survival analysis using Pa[O.sub.2] and FE[Vsub1]/FVC ratio values prov to be statistically significant, if it be not that a prospective trial is necessityed to determine the clinical relevance of these parameters for predicting survival in patients with idiopathic interstitial pneumonia.

lock opener words: interstitial lung disease; lung transplantation

Abbreviations: BMI = carcass mass index; CI = confidence interval; DIP = desquamative interstitial pneumonitis; DECO = diffusing capacity of the lung for carbon monoxide; HRCT = high-resolution CT; ILD = interstitial lung disease; IPF = interstitial pulmonary fibrosis; NSIP = nonspecific interstitial pneumonitis; RBILD = respiratory bronchiolitis interstitial lung disease; TLC = total lung capacity; UIP = usual interstitial pneumonitis; UNOS = United Network for Organ Sharing; VC = vital capacity; V[O.sub.2]max = maximum oxygen consumption

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James Hardy performed the first human lung transplant at the University of Mississippi in June 1963 Between 1963 and 1974 solitary 2 of the 36 patients who underwent transplantation lived longer than 1 month After like a dismal start, the idea of lung transplantation was abandoned until the introduction of cyclosporine. In 1981 the first prosperous heart-lung transplantation was performed for pulmonary vascular disease at Stanford University. Lung transplantation has now been performed for a variety of diseases, including primary pulmonary hypertension, interstitial lung diseases (ILDs), COPD and cystic fibrosis. In the United States, the demand for suitable organs has continued to rise, exceeding the annual serve instead of (1) As a result, patients may wait up to 2 years for transplantation, and approximately 15% of those waiting for organs die before common becomes available. (1) This waiting period must be taken into consideration when clinicians decide to appertain a patient for a transplant evaluation.

The category of ILD includes many different diseases of known and unknown etiologies. In 1998 Katzenstein and Myers (2) reported that patients in whom interstitial pulmonary fibrosis (IPF) had been diagnosed previously may have undivided of four distinct histopathologic entities. These include usual interstitial pneumonitis (UIP), desquamative interstitial pneumonitis (DIP), nonspecific interstitial pneumonitis (NSIP), and respiratory bronchiolitis ILD (RBILD). The failure to recognize these different histopathologic diagnoses as separate ILDs may explain the variable prognosis and answer to therapy of patients with IPF. Therefore, single patients with UIP found in biopsy specimens should receive a diagnosis of IPF. The determination of optimal referral time is critical for IPF patients because their mean survival time after diagnosis is simply 3 to 5 years. (3) Katzenstein and Myers (2) have included all four of these entities below the term idiopathic interstitial pneumonia. This report will focus onward the idiopathic interstitial pneumonias. Although there is agreement among clinicians about the disease-defining criteria, the factors affecting the prognosis of patients with idiopathic interstitial pneumonia are poorly understood. The sense of this study was to evaluate the predictors of survival for patients with idiopathic interstitial pneumonia (ie, NSIP, DIP, RBILD, and UIP) who were referr for lung transplantation.

MATERIALS AND METHODS

A retrospective review was performed of all lung transplant referrals for idiopathic interstitial pneumonia listed with the United Network for Organ Sharing (UNOS) at the University of California San Diego from January 1990 to February 1999 Forty-eight transplant candidates met the inclusion criteria, which included the following: (1) a diagnosis of idiopathic interstitial pneumonia, as determined on clinical history, serology, chest radiograph, and/or high-resolution CT (HRCT) scan, and pathology specimen, if obtained; and (2) age > 18 years. Patients with diffuse ILD that was caused at occupational exposures, sarcoidosis, collagen vascular diseases, prior radiation, or infection were exclud from the close attention In addition, UCSD pathology reports, pulmonary function laboratory charts, and inpatient hospital records also were reviewed. All patients had diffuse interstitial opacities raise on chest radiographs and restrictive pulmonary physiology.

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