Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers
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Published on: February 14, 2022
Sameep Sehgal1, Kelly M Pennington2,3, Huaqing Zhao4
1Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
Abstract:
Lung transplantation in patients with systemic sclerosis (SSc) can be complicated by extrapulmonary manifestations of the disease, leading to concerns regarding posttransplant complications and outcomes.
Methods:
We conducted a web-based survey of adult lung transplant programs in the United States regarding their practices in patients with SSc.
Results:
Sixty percent (37/62) of the eligible centers responded to the survey, majority of the respondents were medical directors (81%). Most centers would consider transplanting patients with mild or moderate esophageal disease (92% or 75%, respectively) or gastroparesis (59%). A minority would consider patients with severe esophageal dysmotility (37%), digital ulcers (21%), or low body mass index (19%). Most centers conducted extensive pretransplant gastrointestinal evaluation and use a conservative feeding approach with prolonged nothing by mouth (83%) and postpyloric feeding (89%). Antireflux surgery is commonly considered (40%) with partial fundoplication being the procedure of choice (67%). Most respondents expected similar outcomes of acute or chronic rejection (81% and 51%, respectively), respiratory infections (76%), and 1-year survival (70%).
Conclusions:
Most US lung transplant centers do not universally exclude SSc from lung transplant listing, but most support extensive pretransplant gastrointestinal testing and a conservative approach to feeding in the early posttransplant period.
