ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2697

Gender Disparities in Lung Transplantation in Patients with Systemic Sclerosis-Related Interstitial Lung Disease and Pulmonary Hypertension

Elizabeth Volkmann1, Daniel E. Furst2, Rajeev Saggar3, Philip J. Clements4, Bryant Torres5, Lynne Yoder1 and Rajan Saggar1, 1Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, 2University of California, Los Angeles, CA, 3Cardiothoracic Surgery, University of Arizona College of Medicine, Phoenix, AZ, 4University of California, Los Angeles, Department of Medicine, Los Angeles, CA, 5Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics: Determinants of Disease, Classification and Response

Session Type: Abstract Submissions (ACR)

Background/Purpose: Lung transplantation is often the most viable option for patients with severe systemic sclerosis (SSc)-associated interstitial lung disease (ILD) that is unresponsive to pharmacologic intervention. This study investigates gender differences in lung transplantation rates in patients with SSc-ILD with concomitant precapillary pulmonary hypertension (PH).

Methods: SSc patients with right heart catheterization (RHC)-diagnosed precapillary PH (mean pulmonary artery pressure (mPAP) ≥25 mmHg, pulmonary capillary wedge pressure (PCWP) ≤15 mmHg, and pulmonary vascular resistance (PVR) ≥240 dynesxsecond/cm5) were included. All patients had extensive ILD based on review of high-resolution computed tomography (HRCT) chest imaging and spirometry. Independent t-tests and Fisher’s Exact Test were used to compare differences in continuous and categorical variables, respectively. Logistic regression was used to identify variables associated with lung transplantation.

Results: Of 71 patients with SSc-PH-ILD, 70% were women and 30% were men. Baseline characteristics (ethnicity, SSc type, SSc disease duration), co-morbidities (hypertension, coronary artery disease, diabetes mellitus), and hemodynamic and pulmonary parameters (mPAP, PCWP, PVR, FVC/DLCORatio) were similar for men and women with the exception of age (Mean age (years): Women 56 vs. Men 50, p=0.03). There were no gender differences in median follow up time (All patients: 26 months). In all patients who underwent transplantation, the mPAP was 36.6 (SD 7.7) and the mean forced vital capacity (FVC)% predicted was 50.5 (SD 17.4); there were no differences in mPAP and FVC% predicted between patients who underwent transplantation and those who did not (all p-values =0.2). More men (38%) underwent transplantation than women (12%), p=0.016. The median time to transplantation from RHC was longer for women (21 months) than for men (10 months), p=0.09. In the logistic regression model, male gender (OR 2.3; p=0.02) was the only factor significantly associated with transplantation, even after controlling for severity of ILD and PH.

Conclusion: Among all patients with RHC-diagnosed precapillary PH and extensive ILD, there were no significant differences in mPAP and FVC% predicted between patients who underwent lung transplantation and those who did not. Lung transplantation occurred earlier and more frequently in men than in women with SSc-PH-ILD, even after accounting for severity of ILD and PH.

Disclosure:

E. Volkmann,
None;

D. E. Furst,
None;

R. Saggar,
None;

P. J. Clements,
None;

B. Torres,
None;

L. Yoder,
None;

R. Saggar,
None.

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