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.
D. E. Furst,
P. J. Clements,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gender-disparities-in-lung-transplantation-in-patients-with-systemic-sclerosis-related-interstitial-lung-disease-and-pulmonary-hypertension/