Outcomes of lung transplantation for end stage lung disease with connective tissue disease: a systematic review and meta-analysis

Abstract

Abstract Background Lung transplantation is the most important treatment for end-stage lung disease. However, the clinical outcomes of lung transplantation in patients with connective tissue disease(CTD) complicated with end-stage pulmonary complications are unclear. Consequently, we performed a systematic review and meta-analysis to compare the survival rates and incidences of adverse events between patients with and without CTD who underwent lung transplantation for end-stage lung disease. Methods We searched the PubMed, Embase, Web of Science, Cochrane, Wanfang, VIP, CNKI, and CBM databases from their inception until October 18, 2023, for eligible studies. A meta-analysis of each study was performed using State14.0 with a 95% confidence interval (CI). A randomized or fixed-effect model was applied according to the heterogeneity test. The systematic review was registered in PROSPERO (CRD42023483687). Results Our final analysis included 12 publications on 369 patients with CTD and 2,165 without, all of whom underwent lung transplantation. The survival at 1 month (OR = 2.20, 95% CI: 0.75–6.47, P = 0.485), 6 months (OR = 0.61, 95% CI: 0.33–1.14, P = 0.099), 1 year (OR = 1.05, 95% CI: 0.66–1.66, P = 0.982), 2 years (OR = 0.50, 95% CI: 0.23–1.06, P = 0.096), 3 years(OR = 1.11, 95% CI: 0.70–1.78, P = 0.703) and 5 years (OR = 2.08, 95% CI: 1.11–3.91, P = 0.027), grade 3 primary graft dysfunction (PGD) incidence (OR = 1.33, 95% CI: 0.68–2.60, P = 0.184), rejection events incidence (OR = 1.19, 95% CI: 0.61–2.32, P = 0.607) and intensive care unit (ICU) LOS (SMD = 0.54, 95% CI:-0.26-1.34, P = 0.187) were similar between the two groups. Patients with CTD had a greater risk of PGD incidence (OR = 2.91, 95% CI: 1.43–5.95, P = 0.003), a longer post-transplant hospital length of stay (LOS) (SMD = 0.52, 95% CI: 0.09–0.96, P = 0.009) and post-transplant time to extubation (SMD = 0.68, 95% CI: 0.12–1.25, P = 0.023). Conclusions The survival rate and the incidence of grade 3 PGD in CTD patients after lung transplantation are comparable to those of other patients undergoing lung transplantation for end-stage lung disease. Thus, Lung transplantation should be a strongly considered therapeutic option for patients with CTD who are suffering from end-stage lung disease. Nevertheless, when selecting patients with CTD for lung transplantation, it is crucial to focus on enhancing perioperative management to reduce the burden of hospitalization post-transplantation.

Keywords

• Connective tissue disease
• Lung transplantation
• Primary graft dysfunction
• Meta-analysis