Lung Transplant Outcomes for Idiopathic Pulmonary Fibrosis: Are We Improving?

BACKGROUND

After implementation of the Lung Allocation Score in 2005, idiopathic pulmonary fibrosis (IPF) emerged as the most common indication for lung transplantation (LT) in the United States. The age and comorbidity of patients undergoing LT have since increased, and the indications for LT have evolved. However, limited data have been used to analyze more recent outcomes among the IPF population.

METHODS

This study analyzed LTs for the primary indication of IPF by using the United Network for Organ Sharing database. An eras-based analysis was performed, comparing patient characteristics, survival, and related outcomes during 2005 to 2009 (era 1) and 2010 to 2014 (era 2) with χ2, Wilcoxon rank sum, and Kaplan-Meier analyses. The study compared 1-year survival from 2005 to 2020 and survival at milestones ranging from 1 month to 5 years. Two adjusted Cox proportional hazards models were conducted: 5-year survival by era and 1-year survival annually from 2010 to 2020.

RESULTS

From era 1 (n = 1818) to era 2 (n = 3227), the median age of LT recipients increased from 61 to 63 years (P < .001). The percentage of patients in the intensive care unit before LT climbed from 7.7% to 12.1% (P < .001), and the percentage of patients with diabetes grew from 17.9% to 19.4% (P = .003). Despite increased severity of illness, 5-year survival increased from 51.9% in era 1 to 55.2% in era 2 (P = .02). Adjusted modeling indicated that LT during era 2 featured a 17% hazard reduction compared with era 1 (hazard ratio, 0.83; 95% CI, 0.76-0.91).

CONCLUSIONS

Survival is improving for patients undergoing LT for IPF, despite the challenges of transplant recipients with progressively higher risk profiles.

Prescription patterns for metastatic breast cancer patients previously treated with anthracycline and taxane: An assessment in a United States managed care database

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Background: There is a scarcity of literature documenting actual prescription patterns for metastatic breast cancer (MBC) patients. The objective of this study was to describe the pattern of dispensing chemotherapy agents among MBC patients previously exposed to anthracycline and taxane in the managed care setting. Methods: Study cohort was extracted from the PharMetrics database between 1/1999 through 6/2005, who were =18 years, enrolled =6 months with =2 ICD-9-CM codes for breast cancer (BC), =1 ICD-9-CM code for distant metastases, and =1 NDC/J-code for anthracycline and taxane. A 21 day treatment interval was assigned to all agents to identify treatment regimens. If types of agents in consecutive intervals were the same, they were collapsed into one regimen disregarding the sequence. Following the reference date, the dispense date of the first anthracycline or taxane prescription, whichever occurred later, the first regimen was treated as reference regimen. Following this regimen, sequential monotherapy or combination therapy was identified in a chronological order. Results: Of the 1,028 who met inclusion criteria, 67% (n=691) did not receive a sequential therapy. Of the 33% (n=337) who did, the first sequential regimen for 177 was monotherapy and 160 combination therapy. The most common agents within the monotherapy regimens were taxanes 28%, capecitabine 20%, and trastuzumab 18%. For combination, taxane/trastuzumab 9.4%, vinorelbine/trastuzumab 9.4%, and carboplatin/taxane 8.8%. Of those who received sequential therapy, 68% were retreated with a taxane; 34% with docetaxel and 46% with paclitaxel. Conclusions: In this study, the majority of the population did not receive sequential therapy. This may have been due to loss to follow up, the duration of the reference regimen (lasting throughout the study period(s) after collapsing), or treatment in the inpatient setting where chemotherapy agents are not identifiable in this claims database. Taxane was the most common agent received in the first sequential therapy, both for monotherapy and combination therapy. A high proportion of patients with sequential therapy were retreated with a taxane.

No significant financial relationships to disclose.

Characterization of (1'R,4S,4aR,7S,7aR)-dihydronepetalactol as a semiochemical for lacewings, including Chrysopa spp. and Peyerimhoffina gracilis

The enantiomerically pure diastereoisomers (1R,4S,4aR,7S,7aR)- (1) and (1R,4R,4aR,7S,7aR)-dihydronepetalactol (2) were synthesized diastereoselectively from a renewable resource, (4aS,7S,7aR)-nepetalactone (3), isolated as the main constituent of the essential oil of the catmint plant Nepeta cataria. The stereochemistry of the compounds was determined by NMR spectroscopy and X-ray crystallography, and the compounds were identified, respectively, as neomatatabiol and isoneomatatabiol, natural products from Actinidia polygama, for which the lactol stereochemistry was previously incompletely defined. Compound 1 was found to catch significant numbers of three species of lacewing in the field: in Korea. Chrysopa cognata, and in the United Kingdom, Nineta vittata and most notably Peverimhoffina gracilis. All species caught in significant numbers were found more frequently in traps releasing 1 than 2, while more C. cognata, C. formosa, and C. phyllochroma were found in traps releasing (1R,4aS,7S,7aR)-nepetalactol (4). The catch of P. gracilis with 1 is of particular interest as this lacewing has only recently been recorded in the United Kingdom. Where sexed, the lacewings of all species trapped were found to be male, implying a possible pheromonal role for these or structurally related compounds.

Electroantennogram and behavioural responses of different forms of the bird cherry-oat aphid, Rhopalosiphum padi, to sex pheromone and a plant volatile

Winged (alate) virginoparae were induced in the laboratory by crowding the bird cherry-oat aphid, Rhopalosiphum padi (L.) under long-day conditions. Males and gynoparae (the winged female form that produces sexual females) were induced by short days. Electroantennogram (EAG) and behavioural responses were investigated in each of the three forms to two aphid sex pheromone components, (-)-(4aS,7S,7aR)-nepetalactol and (+)-(4aS,7S,7aR)-nepetalactone, and benzaldehyde, a volatile which is released by the winter host plant. All three compounds elicited EAG responses with the males showing the highest sensitivity to each compound. Both the nepetalactol and the nepetalactone elicited larger EAG responses in gynoparae than in the winged virginoparae but antennae from virginoparae were more responsive to benzaldehyde. Although the nepetalactone is not a sex pheromone component in R. padi the EAG responses were similar to those evoked by the nepetalactol, the sex pheromone, in all three aphid forms. In a linear-track olfactometer, significantly more male R. padi moved into air containing nepetalactol, nepetalactone or benzaldehyde than into a simultaneous choice of clean air (i.e. attraction) but nepetalactol was more attractive than nepetalactone. Males, however, showed no response to a mixture of nepetalactol and nepetalactone. Gynoparae were attracted only to the nepetalactol but were less sensitive than the males and showed no response to the nepetalactone or benzaldehyde. In contrast, alate virginoparae showed no behavioural responses to any of the compounds. The present study supports the idea that the male R. padi utilise both sex pheromone and benzaldehyde for mate/host-plant location in autumn. It also demonstrates, for the first time, polyphenic differences in the olfactory responses at the peripheral level between the two female forms. Such differences impact on the life-cycle strategy where winged virginoparae move between graminaceous summer host plants while gynoparae move from the summer hosts to the bird cherry, winter host. The latter move appears to be assisted by the sex pheromone released by sexual females, already present on that host, acting as an aggregation pheromone.