■间质性肺病(ILD)对药物治疗无反应通常需要肺移植(LTx),延长了生命和生存质量。LTx转诊的理想时机仍然具有挑战性,延迟转诊与显著的发病率和死亡率相关。在其他标准中,如果强制肺活量(FVC)低于80%或一氧化碳扩散能力(DLCO)低于40%,ILD患者应考虑接受LTx治疗.然而,缺乏转诊率的数据。
■根据肺功能测试(PFTs)评估LTx的转诊率,并确定与非转诊相关的障碍。
■单中心回顾性队列研究。
■该研究包括2014年至2020年进行PFT的ILD患者。FVC<80%或DLCO<40%的患者纳入研究。有LTx绝对禁忌症的患者被排除在外。计算了转诊率,并对转诊和未转诊的受试者进行了比较。
■在114名符合转诊LTx标准的ILD患者中,35人被推荐(30.7%),7继续接受LTx。从PFT到转诊评估的中位时间为255天[四分位距(IQR)35-1077]。转诊至LTx的中位时间为89天(IQR59-143)。转诊患者较年轻(p=0.003),FVC较低(p<0.001),DLCO(p<0.001),肺动脉高压的发生率较高(p=0.04)。相对更好的PFT,年龄更大,与未转诊的患者显著相关。
■有资格获得LTx的ILD患者的转诊不足,这与严重的疾病和错过LTx的机会有关。需要进一步的研究来验证这些发现。
肺移植:解决肺部疾病患者的转诊差距对药物治疗无反应的严重肺部疾病患者通常需要肺移植来提高他们的生活质量和生存率。确定考虑移植的最佳时机是具有挑战性的,因为延迟会导致并发症。我们的研究旨在评估患有肺部疾病的人的频率,尤其是间质性肺病,根据肺功能检查转诊为肺移植。我们对2014年至2020年间接受肺功能检查的肺部疾病患者的病历进行了回顾性分析。我们选择了检查结果显示肺功能受损的患者,排除因其他医疗原因不符合肺移植资格的人。随后,我们检查了转诊进行肺移植的患者数量,并将其与未转诊的患者进行了比较。我们的发现显示,在114名符合肺移植资格的患者中,只有35人被提及,代表约31%的转诊率。其中,实际上只有7名患者接受了移植手术。从肺功能测试到转诊进行移植评估之间的时间非常长,平均约255天。此外,一旦提到,患者平均等待89天进行移植评估.转诊的患者往往更年轻,肺部疾病更严重,其特征是肺功能测试结果较低,肺动脉高压的可能性较高。相反,未转诊的患者总体健康状况较好,且年龄较大.这种差异凸显了患者通过肺移植改善健康和生活质量的机会。进一步的研究对于验证这些发现的准确性至关重要,但是这项研究代表了确保肺部疾病患者获得所需适当护理的关键一步。
Interstitial lung diseases (ILD) unresponsive to medical therapy often require lung transplantation (LTx), which prolongs quality of life and survival. Ideal timing for referral for LTx remains challenging, with late referral associated with significant morbidity and mortality. Among other criteria, patients with ILD should be considered for LTx if forced vital capacity (FVC) is less than 80% or diffusion capacity for carbon monoxide (DLCO) is less than 40%. However, data on referral rates are lacking.
To evaluate referral rates for LTx based on pulmonary function tests (PFTs) and identify barriers associated with non-referral.
A single-center retrospective cohort
study.
The
study consisted of ILD patients who performed PFT between 2014 and 2020. Patients with FVC < 80% or a DLCO < 40% were included in the
study. Patients with absolute contraindications to LTx were excluded. Referral rates were computed, and a comparison was made between referred and non-referred subjects.
Out of 114 ILD patients meeting criteria for referral to LTx, 35 were referred (30.7%), and 7 proceeded to undergo LTx. Median time from PFT to referral for assessment was 255 days [interquartile range (IQR) 35-1077]. Median time from referral to LTx was 89 days (IQR 59-143). Referred patients were younger (p = 0.003), had lower FVC (p < 0.001), DLCO (p < 0.001), and a higher rate of pulmonary hypertension (p = 0.04). Relatively better PFT, and older age, were significantly associated with non-referral of patients.
There is under-referral of ILD patients who are eligible for LTx, which is associated with severe disease and missed opportunities for LTx. Further research is required to validate these findings.
Lung transplants: addressing referral gaps for lung disease patientsPatients with severe lung diseases that are unresponsive to medical treatments often require lung transplants to enhance their quality of life and survival. Determining the optimal timing for considering a transplant is challenging, as delaying it can lead to complications. Our
study aimed to assess how frequently individuals with lung problems, particularly interstitial lung diseases, were referred for lung transplants based on lung function tests. We conducted a retrospective analysis of medical records for patients with lung diseases who underwent lung function tests between 2014 and 2020. We selected patients whose test results indicated impaired lung function, excluding those who were ineligible for lung transplants due to other medical reasons. Subsequently, we examined the number of patients referred for a lung transplant and compared them to those who were not referred. Our findings revealed that out of 114 patients eligible for a lung transplant, only 35 were referred, representing a referral rate of approximately 31%. Among these, only 7 patients actually underwent the transplant procedure. The time elapsed between the lung function test and the referral for a transplant assessment was notably long, averaging around 255 days. Additionally, once referred, patients waited an average of 89 days for the transplant assessment. Referred patients tended to be younger and had more severe lung disease, characterized by lower lung function test results and a higher likelihood of pulmonary hypertension. Conversely, patients who were not referred generally enjoyed better overall health and were older. This discrepancy highlights the missed opportunities for patients to improve their health and quality of life through lung transplantation. Further research is essential to verify the accuracy of these findings, but this
study represents a crucial step toward ensuring that individuals with lung diseases receive the appropriate care they require.