Outcomes of lung transplantation for end stage lung disease with connective tissue disease: a systematic review and meta-analysis.

Abstract

Background: Lung transplantation is the most important treatment for end-stage lung disease. However, the clinical outcomes of lung transplantation in patients with connective tissue disease(CTD) complicated with end-stage pulmonary complications are unclear. Consequently, we performed a systematic review and meta-analysis to compare the survival rates and incidences of adverse events between patients with and without CTD who underwent lung transplantation for end-stage lung disease.

Methods: We searched the PubMed, Embase, Web of Science, Cochrane, Wanfang, VIP, CNKI, and CBM databases from their inception until October 18, 2023, for eligible studies. A meta-analysis of each study was performed using State14.0 with a 95% confidence interval (CI). A randomized or fixed-effect model was applied according to the heterogeneity test. The systematic review was registered in PROSPERO (CRD42023483687).

Results: Our final analysis included 12 publications on 369 patients with CTD and 2,165 without, all of whom underwent lung transplantation. The survival at 1 month (OR = 2.20, 95% CI: 0.75-6.47, P = 0.485), 6 months (OR = 0.61, 95% CI: 0.33-1.14, P = 0.099), 1 year (OR = 1.05, 95% CI: 0.66-1.66, P = 0.982), 2 years (OR = 0.50, 95% CI: 0.23-1.06, P = 0.096), 3 years(OR = 1.11, 95% CI: 0.70-1.78, P = 0.703) and 5 years (OR = 2.08, 95% CI: 1.11-3.91, P = 0.027), grade 3 primary graft dysfunction (PGD) incidence (OR = 1.33, 95% CI: 0.68-2.60, P = 0.184), rejection events incidence (OR = 1.19, 95% CI: 0.61-2.32, P = 0.607) and intensive care unit (ICU) LOS (SMD = 0.54, 95% CI:-0.26-1.34, P = 0.187) were similar between the two groups. Patients with CTD had a greater risk of PGD incidence (OR = 2.91, 95% CI: 1.43-5.95, P = 0.003), a longer post-transplant hospital length of stay (LOS) (SMD = 0.52, 95% CI: 0.09-0.96, P = 0.009) and post-transplant time to extubation (SMD = 0.68, 95% CI: 0.12-1.25, P = 0.023).

Conclusions: The survival rate and the incidence of grade 3 PGD in CTD patients after lung transplantation are comparable to those of other patients undergoing lung transplantation for end-stage lung disease. Thus, Lung transplantation should be a strongly considered therapeutic option for patients with CTD who are suffering from end-stage lung disease. Nevertheless, when selecting patients with CTD for lung transplantation, it is crucial to focus on enhancing perioperative management to reduce the burden of hospitalization post-transplantation.