Comparing effectiveness of prognostic tests in idiopathic pulmonary fibrosis

Prognostic value of [18F]FDG PET/CT in patients with idiopathic pulmonary fibrosis

The study investigates the prognostic value of [18F]fluorodeoxyglucose (FDG) PET/CT in patients with idiopathic pulmonary fibrosis (IPF). A total of 346 IPF patients who underwent FDG PET/CT between 2007 and 2020 were analyzed. Pulmonary FDG uptake [target to background ratio (TBR)] was binarized by optimal cut-off value based on survival analysis. The PET-modified GAP (Gender, Age, lung Physiology) score-based staging system included a category for FDG uptake, and its prognostic prediction was compared with the conventional GAP score. Survival analyses were conducted for progression-free, overall, and disease-specific survival. The low FDG uptake group showed a significantly better prognosis than the high uptake group, with cut-off values of 7.26 (p < 0.001), 7.15 (p = 0.04), and 9.23 (p = 0.01) for progression-free, overall, and disease-specific survival, respectively. The PET-modified GAP score-based staging system differentiated better than the conventional GAP system, particularly between stages I and II in overall survival (p = 0.001 vs. p = 0.08). For disease-specific survival, the PET-modified model showed better performance than the original GAP model (p = 0.06 vs. p = 0.33), though neither was statistically significant. Pulmonary FDG uptake in PET/CT is a reliable biomarker for predicting the prognosis of IPF patients and enhances the conventional GAP staging system's predictive value for patient survival.

Monogenic gene variants in lung transplant recipients with usual interstitial pneumonia

Aim

The prevalence of monogenic disease-causing gene variants in lung transplant recipients with idiopathic pulmonary fibrosis is not fully known. Their impact on clinical outcomes before and after transplantation requires more evidence.

Patients and methods

We retrospectively performed sequence analysis of genes associated with pulmonary fibrosis in a cohort of 23 patients with histologically confirmed usual interstitial pneumonia that had previously undergone double lung transplantation. We evaluated the impact of confirmed molecular diagnoses on disease progression, clinical outcomes and incidence of acute rejection or chronic lung allograft dysfunction after transplantation.

Results

15 patients out of 23 (65%) had a variant in a gene associated with interstitial lung disease. 11 patients (48%) received a molecular diagnosis, of which nine involved genes for telomerase function. Five diagnostic variants were found in the gene for Telomerase reverse transcriptase. Two of these variants, p.(Asp684Gly) and p.(Arg774*), seemed to be enriched in Finnish lung transplant recipients. Disease progression and the incidence of acute rejection and chronic lung allograft dysfunction was similar between patients with telomere-related disease and the rest of the study population. The incidence of renal or bone marrow insufficiency or skin malignancies did not differ between the groups.

Conclusion

Genetic variants are common in lung transplant recipients with pulmonary fibrosis and are most often related to telomerase function. A molecular diagnosis for telomeropathy does not seem to impact disease progression or the risk of complications or allograft dysfunction after transplantation.

A molecular diagnosis is common in lung transplant recipients with usual interstitial pneumonia and frequently reveals variants in genes related to telomerase function. This finding is not associated with increased risk of allograft dysfunction.https://bit.ly/30ucMQy

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

Tens of thousands of patients with advanced lung diseases may be eligible to be considered as potential candidates for lung transplant around the world each year. The timing of referral, evaluation, determination of candidacy, and listing of candidates continues to pose challenges and even ethical dilemmas. To address these challenges, the International Society for Heart and Lung Transplantation appointed an international group of members to review the literature, to consider recent advances in the management of advanced lung diseases, and to update prior consensus documents on the selection of lung transplant candidates. The purpose of this updated consensus document is to assist providers throughout the world who are caring for patients with pulmonary disease to identify potential candidates for lung transplant, to optimize the timing of the referral of these patients to lung transplant centers, and to provide transplant centers with a framework for evaluating and selecting candidates. In addition to addressing general considerations and providing disease specific recommendations for referral and listing, this updated consensus document includes an ethical framework, a recognition of the variability in acceptance of risk between transplant centers, and establishes a system to account for how a combination of risk factors may be taken into consideration in candidate selection for lung transplantation.