Lung Transplantation for Interstitial Lung Disease: A Northern Ireland Cohort Study

Lung transplantation (LTx) is the definitive treatment for advanced fibrotic interstitial lung disease (ILD), but referral timing remains challenging. Data on outcomes of Northern Ireland (NI) patients referred for LTx are limited.

In this multicentre retrospective cohort study, all ILD referrals for LTx from the five NI healthcare trusts between January 2014 and March 2024 were analysed. Demographic, clinical, lung function and transplant outcome data were extracted from electronic health records. Patients were classified according to transplant assessment and listing outcomes.

One hundred thirty-eight patients were referred (median age 60.5 years; 64.5% male; 35.5% female); idiopathic pulmonary fibrosis was the most common diagnosis (44.2%). Of 138 referred patients, 64 (46.4%) were considered suitable for advanced LTx assessment, while 68 (49.3%) were unsuitable and 6 (4.3%) declined further assessment. Of those suitable for advanced assessment, 28 (43.8%) were listed for transplantation and 11 (17.2%) died before completion of assessment. Age was the only independent predictor of mortality before assessment completion, increasing risk by 13.9% per year (p = 0.011). The median interval between initial referral to LTx satellite clinic review was 131.5 days for the eligible cohort. The median interval from initial transplant clinic review to advanced assessment was 80 days excluding those patients with intentional pathway prolongation due to a watch-and-wait approach. Forty-five per cent of pre-transplant investigations, particularly coronary angiography, occurred > 6 months after satellite clinic review and may have contributed to some delays from referral to advanced assessment. Of patients listed for transplantation, 14 (50.0%) died while waiting, 11 (39.3%) underwent LTx, and 3 remained active on the waiting list.

Nearly half of ILD referrals were unsuitable for advanced LTx assessment, largely because of age and comorbidity. Delays in assessment pathways, for example watchful waiting and access to coronary angiography, may contribute to high pre-transplant mortality. Earlier referral and streamlined investigation pathways may improve transplantation outcomes.