Lung Transplantation in Rheumatoid Arthritis Related Interstitial Lung Disease: Risk Factors and Mortality in a Universal Health Care System
Lee M. Fidler, Omri A. Arbiv, Joseph S. Munn, Jolene H. Fisher, Shane Shapera, Peter C. Austin, Andrea S. GershonABSTRACT
Background
Despite therapy, some patients with rheumatoid arthritis related interstitial lung disease (RA‐ILD) require lung transplantation for progressive disease. We aimed to identify factors associated with lung transplantation and post‐transplantation survival in RA‐ILD.
Methods
We performed a retrospective observational cohort study using data from Ontario, Canada between 2003 and 2022. RA‐ILD patients were identified from the Ontario RA Database. We used a cause‐specific hazards model, considering the competing risk of death, to identify factors associated with lung transplantation. A Cox proportional hazards model was used to evaluate post‐transplant survival.
Results
Among 6470 RA‐ILD patients, 77 (1.2%) underwent lung transplantation, equating to 2.40 transplants per 1000 person years. The median time to transplant was 3.7 years. Younger age [HR 0.93 per increasing year (95%CI 0.91–0.95), p < 0.0001], male sex [HR 2.40 (95%CI 1.523.78), p = 0.0002], and comorbid diabetes [HR 1.70 (95%CI 1.06–2.73), p = 0.003], congestive heart failure [HR 1.87 (95%CI 1.15–3.04), p = 0.01] and COPD [HR 2.14 (95%CI 1.25–3.68), p = 0.006] were associated with transplantation. The median survival following transplantation was 4.3 years.
Conclusion
Lung transplantation is an uncommon, but important therapy for RA‐ILD. Select comorbidities are associated with lung transplantation. Post‐transplant survival among RA‐ILD patients in Ontario was comparable to that reported elsewhere.