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Original Research: Transplantation |

Lung Transplantation for Hypersensitivity PneumonitisLung Transplant for Hypersensitivity Pneumonitis

Ryan M. Kern, MD; Jonathan P. Singer, MD, MPH; Laura Koth, MD; Joshua Mooney, MD; Jeff Golden, MD; Steven Hays, MD; John Greenland, MD, PhD; Paul Wolters, MD; Emily Ghio, MSc; Kirk D. Jones, MD; Lorriana Leard, MD, FCCP; Jasleen Kukreja, MD, MPH; Paul D. Blanc, MD, MSPH, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (Drs Kern, Singer, Koth, Golden, Hays, Greenland, Wolters, Leard, and Blanc and Ms Ghio), Department of Pathology, Pulmonary Pathology and Cytopathology (Dr Jones), Division of Cardiothoracic Surgery (Dr Kukreja), and Division of Occupational and Environmental Medicine (Dr Blanc), University of California San Francisco, San Francisco; and the Division of Pulmonary and Critical Care Medicine (Dr Mooney), Stanford University, Palo Alto, CA.

CORRESPONDENCE TO: Ryan Kern, MD, 200 First St SW, Rochester, MN 55905; e-mail: ryanmkern@gmail.com


Dr Kern is currently at the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic (Rochester, MN).

FUNDING/SUPPORT: Dr Kern receives funding from the National Institutes of Health [Grant 5T32HL007185-37]. Dr Singer received a University-based grant to study the impact of preoperative frailty and sarcopenia on outcomes following lung transplantation. No salary support was provided. Dr Singer also receives funding from a National Heart, Lung, and Blood Institute grant [Grant K23 HL111115]. This work was supported in part by Health Resources and Services Administration [contract 234-2005-37011C].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1558-1565. doi:10.1378/chest.14-1543
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BACKGROUND:  Hypersensitivity pneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may necessitate the need for lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared with referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF).

METHODS:  To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000 to 2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to referents with IPF. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling.

RESULTS:  We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared with IPF was 96%, 89%, and 89% vs 86%, 67%, and 49%, respectively. Subjects with HP manifested a reduced adjusted risk for death compared with subjects with IPF (hazard ratio, 0.25; 95% CI, 0.08-0.74; P = .013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in five (16%). Two subjects developed recurrent HP in their allografts.

CONCLUSIONS:  Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk for death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.

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