Forced vital capacity reduction severity in pulmonary fibrosis and post-lung transplantation outcomes

The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD.

Recipients from the French multicentric COLT cohort who underwent lung transplantation for ILD were included in this study. FVC was assessed to determine if the severity of its reduction is associated with post-transplant outcomes. 311 recipients were included in the study. FVC was identified as a significant risk factor for mortality at one year in multivariate analysis (p = 0.003). The ROC curve for FVC estimated the probability of death at one year with an area under the curve of 64 % (95 % confidence interval 57-71 %) and defined an optimal FVC threshold of 46 %. Recipients with an FVC ≤46 % were more likely to be listed as emergency cases, had lower FVC at one year, and exhibited reduced short- and long-term survival.

The severity of pre-transplant FVC reduction is a risk factor for poorer post-transplant outcomes. The findings should stimulate discussion about benefits of LTx for patients with lower FVC. An FVC threshold of ≤46 % should be considered in discussions about lung transplantation indications, decisions regarding single lung transplantation, and the selection of smaller donor lungs. Respirologists managing patients with ILD should consider early referral to a LTx center.