Letters Idiopathic pulmonary fibrosis

Authors’ reply to Riddell and colleagues

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g168 (Published 15 January 2014) Cite this as: BMJ 2014;348:g168
  1. Owen J Dempsey, consultant chest physician1,
  2. David Miller, clinical lecturer2
  1. 1Grampian Interstitial Lung Disease Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
  2. 2Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
  1. owen.dempsey{at}nhs.net

We thank Riddell and colleagues for their important comments emphasising the role of lung transplantation in patients with idiopathic pulmonary fibrosis (IPF).1 Space precluded detailed discussion of this topic, but it is tackled in the latest IPF guidelines, which recommend considering transplantation in all patients without absolute contraindications, with referral ideally within first six months of a confident diagnosis.2

With regard to the maximum age, the 2008 British Thoracic guidelines suggested considering transplantation for IPF in “those who fulfil established selection criteria . . . thus generally excluding those over the age of 65 years of age and/or those with significant co-morbidity.”3 Riddell raises the important point, however, that carefully selected patients over 65 years may still show clinical benefit. This is highly relevant given the median age of onset for IPF is around 70 years and we routinely see chronologically “elderly” but biologically youthful patients with this devastating disease. Worldwide there has been a striking increase in the number of transplants being performed in those over 65 years of age—only 138 lung transplants for IPF were performed between 2000 and 2005, whereas in 2006-12 this had risen to 1061.4 Median survival (estimated time by which 50% of transplant recipients had died) was only marginally reduced in those under 65 years (3.8 years) compared with those aged 50-65 years (4.3 years). Perhaps this point requires more emphasis in routine clinical practice and more timely referral for transplantation.

Notes

Cite this as: BMJ 2014;348:g168

Footnotes

  • Competing interests: None declared.

References

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