Timing of Lung Transplantation for Patients with Fibrotic Lung Diseases

ABSTRACT

Idiopathic pulmonary fibrosis (IPF) is typically a fatal disease that fails to respond to medical therapy. For these patients lung transplantation offers the promise of improved quality and duration of life. The initial reports of successful transplantation for IPF date back to the mid-1980s although recent data suggest IPF patients make up nearly 20% of all single lung transplants. The survival rates following lung transplantation for IPF are estimated at 67% for 1 year, 52% for 3 years, and 35% for 5 years. Mortality rates following lung transplantation for IPF are higher than emphysema, but are generally comparable to primary pulmonary hypertension. Given the relatively high mortality following transplant the decision of when to transplant a patient is of paramount importance. Although individual patients differ, generalizations predicting a poor prognosis include the diagnosis of usual interstitial pneumonia (UIP), a forced vital capacity or total lung capacity of less than 65% predicted, a diffusion capacity for carbon monoxide (DL_CO) less than 45% of predicted, and the presence of extensive honeycombing on high-resolution computed tomographic scans. The presence of any of these features should prompt the patient and physician to consider lung transplantation as a potential therapeutic modality. Patients with interstitial lung disease related to collagen vascular diseases or other causes need to be considered on an individual basis; their prognosis is usually better than patients with IPF, and the potential for systemic involvement may preclude listing for lung transplantation.

KEYWORD

Idiopathic pulmonary fibrosis - cryptogenic fibrosing alveolitis - interstitial lung disease - collagen vascular disease - nonspecific interstitial pneumonia - lung transplantation

REFERENCES

• 1 Trulock E P. Lung transplantation.  Am J Respir Crit Care Med . 1997;  155 789-818
• 2 1999 Annual Report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network: Transplant Data: 1989-1998. Rockville, Md: U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation; Richmond, Va: UNOS
• 3 Egan J. Pharmacologic therapy of idiopathic pulmonary fibrosis.  J Heart Lung Transplant . 1998;  171 1039-1044
• 4 Hosenpud J D, Bennett L E, Keck B M. The Registry of the International Society for Heart and Lung Transplantation: fifteenth official report-1998.  J Heart Lung Transplant . 1998;  17 656-668
• 5 Hosenpud J D, Bennett L E, Keck B M. The Registry of the International Society for Heart and Lung Transplantation: eighteenth official report-2001.  J Heart Lung Transplant . 2001;  20 805-815
• 6 Unilateral lung transplantation for pulmonary fibrosis. Toronto Lung Transplant Group.  N Engl J Med . 1986;  314 1140-1145
• 7 Grossman R F, Frost A, Zamel N. Results of single-lung transplantation for bilateral pulmonary fibrosis. Toronto Lung Transplant Group.  N Engl J Med . 1990;  322 727-733
• 8 Meyers B F, Lynch J P, Trulock E P. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience.  J Thorac Cardiovasc Surg . 2000;  120 99-107
• 9 Harringer W, Wiebe K, Struber M. Lung transplantation: 10-year experience.  Eur J Cardiothorac Surg . 1999;  16 546-554
• 10 Breen T J, Bennett L E, Daily O P. The effect of diagnosis on survival before and after lung transplantation.  J Heart Lung Transplant . 1995;  14 S49
• 11 Hosenpud J D, Bennett L E, Keck B M. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet . 1998;  351 24-27
• 12 De Meester J, Smits J M, Persijn G G. Lung transplant waiting list: differential outcome of type of end-stage lung disease, one year after registration.  J Heart Lung Transplant . 1999;  18 563-571
• 13 De Meester J, Smits J M, Persijn G G. Listing for lung transplantation: life expectancy transplant effect, stratified by type of end-stage lung disease, Eurotransplant experience.  J Heart Lung Transplant . 2001;  20 518-524
• 14 Geertsma A, Ten Vergert M E, Bonsel G J. Does lung transplantation prolong life? A comparison of survival with and without transplantation.  J Heart Lung Transplant . 1998;  17 511-516
• 15 American Thoracic Society. International guidelines for the selection of lung transplant candidates.  Am J of Respir Crit Care Med . 1998;  158 335-339
• 16 Egan T M, Bennett L E, Garrity E R. Predictors of death on the UNOS lung transplant waiting list: results of a multivariate analysis.  J Heart Lung Transplant . 2001;  20 242
• 17 Douglas W W, Ryu J H, Schroeder D R. Idiopathic Pulmonary Fibrosis: Impact of oxygen, colchicine, prednisone or no therapy on survival.  Am J Respir Crit Care Med . 2000;  161 1172-1178
• 18 Hubbard R, Johnston I, Britton J. Survival in patients with cryptogenic fibrosing alveolitis: a population-based cohort study.  Chest . 1998;  113 396-400
• 19 1995 Annual report of the U.S. Scientific Registry of Transplant Recipients and the Organ Procurement Transplantation Network: Transplant Data: 1988-1994. Richmond, Va: United Network for Organ Sharing; Rockville, Md: U.S. Department of Health and Human Services
• 20 American Thoracic Society, European Respiratory Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement.  Am J Respir Crit Care Med . 2000;  161 646-664
• 21 Coultas D B, Zumwalt R E, Black W C. The epidemiology of interstitial lung diseases.  Am J Respir Crit Care Med . 1994;  150 967-972
• 22 Katzenstein A LA, Myers J L. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification.  Am J Respir Crit Care Med . 1998;  157 1301-1315
• 23 Lynch III J P, Toews G B. Idiopathic pulmonary fibrosis. In: Fishman A, ed. Textbook of Pulmonary Diseases and Disorders. 3rd ed. New York: McGraw-Hill 1997: 1193-1210
• 24 Daniil Z D, Gilchrist F C, Nicholson A G. A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med . 1999;  160 899-905
• 25 Mapel D W, Samet J M, Coultas D B. Corticosteroids and the treatment of idiopathic pulmonary fibrosis: past and present, and future.  Chest . 1996;  110 1058-1067
• 26 Nagai S, Kitaichi M, Itoh H. Idiopathic nonspecific interstitial pneumonia/fibrosis: camparison with idiopathic pulmonary fibrosis and BOOP.  Eur Respir J . 1998;  12 1010-1019
• 27 Nicholson A G, Colby T V, du Bois M R. The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med . 2000;  162 2213-2217
• 28 Erbes R, Schaberg T, Loddenkemper R. Lung function tests in patients with idiopathic pulmonary fibrosis. Are they helpful for predicting outcome?.  Chest . 1997;  111 51-57
• 29 Travis W D, Matsui K, Moss J. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia.  Am J Surg Pathol . 2000;  24 19-33
• 30 Carrington C B, Gaensler E A, Coutu R E. Natural history and treated course of usual and desquamative interstitial pneumonia.  N Engl J Med . 1978;  298 801-809
• 31 Johnston I D, Gomm S A, Kalra S. The management of cryptogenic fibrosing alveolitis in three regions of the United Kingdom.  Eur Respir J . 1993;  6 891-893
• 32 Johnston I D, Prescott R J, Chalmers J C. British Thoracic Society study of cryptogenic fibrosing alveolitis: current presentation and initial management. Fibrosing Alveolitis Subcommittee of the Research Committee of the British Thoracic Society.  Thorax . 1997;  52 38-44
• 33 Tukiainen P, Taskinen E, Holsti P. Prognosis of cryptogenic fibrosing alveolitis.  Thorax . 1983;  38 349-355
• 34 Turner-Warwick M, Burrows B, Johnson A. Cryptogenic fibrosing alveolitis: clinical features and their influence on survival.  Thorax . 1980;  35 171-180
• 35 Bjoraker J A, Ryu J H, Edwin M K. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1998;  157 199-203
• 36 Hunninghake G W, Zimmerman M B, Schwartz D A. Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 2001;  164 193-196
• 37 Nishimura K, Kitaichi M, Izumi T. Usual interstitial pneumonia: histologic correlation with high- resolution CT.  Radiology . 1992;  182 337-342
• 38 Hartman T E, Primack S L, Kang E Y. Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia.  Chest . 1996;  110 378-382
• 39 Flaherty K R, Travis W D, Colby T V. Histopathological variability in idiopathic interstitial pneumonia: clinical implications.  Eur Respir J. In press; 
• 40 DeRemee R A, Harrison E G, Andersen H A. The concept of classic interstitial pneumonitis-fibrosis (CIP-F) as a clinicopathologic syndrome.  Chest . 1972;  61 213-220
• 41 Schwartz D A, Van Fossen S D, Davis C S. Determinants of progression in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1994;  149 444-449
• 42 Mapel D W, Hunt W C, Utton R. Idiopathic pulmonary fibrosis: survival in population based and hospital based cohorts.  Thorax . 1998;  53 469-476
• 43 Raghu G, Depaso W J, Cain K. Azathioprine combined with prednisone in the treatment of idiopathic pulmonary fibrosis: a prospective double-blind, randomized, placebo-controlled clinical trial.  Am Rev Respir Dis . 1991;  144 291-296
• 44 Stack B HR, Grant I WB, Irvine W J. Idiopathic diffuse interstitial lung disease: a review of 42 cases.  Am Rev Respir Dis . 1965;  92 939-948
• 45 Winterbauer R H, Hammar S P, Hallman K O. Diffuse interstitial pneumonitis: clinicopathologic correlations in 20 patients treated with prednisone/azathioprine.  Am J Med . 1978;  65 661-672
• 46 Flaherty K R, Martinez F J. The role of pulmonary function testing in pulmonary fibrosis.  Curr Opin Pulm Med . 2000;  6 404-410
• 47 Hanson D, Winterbauer R H, Kirtland S H. Changes in pulmonary function test results after 1 year of therapy as predictors of survival in patients with idiopathic pulmonary fibrosis.  Chest . 1995;  108 305-310
• 48 Gay S E, Kazerooni E A, Toews G B. Idiopathic pulmonary fibrosis: predicting response to therapy and survival.  Am J Respir Crit Care Med . 1998;  157 1063-1072
• 49 Rudd R M, Haslam P L, Turner-Warwick M. Cryptogenic fibrosing alveolitis: relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis.  Am Rev Respir Dis . 1981;  124 1-8
• 50 Xaubet A, Agusti C, Luburich P. Pulmonary function tests and CT scan in the management of idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1998;  158 431-436
• 51 O'Donnell D E. Physiology of interstitial lung disease. In: Schwarz MI, King, TE, eds. Interstitial Lung Disease London: BC Decker Inc, Hamilton 1998
• 52 Cherniack R M, Colby T V, Flint A. Correlation of structure and function in idiopathic pulmonary fibrosis.  Am J Respir Crit Care Med . 1995;  151 1180-1188
• 53 Chinet T, Jaubert F, Dusser D. Effects of inflammation and fibrosis on pulmonary function in diffuse lung fibrosis.  Thorax . 1990;  45 675-678
• 54 Dunn T L, Watters L C, Hendrix C. Gas exchange at a given degree of volume restriction is different in sarcoidosis and idiopathic pulmonary fibrosis.  Am J Med . 1988;  85 221-224
• 55 Jezek V, Fucik J, Michaljanic A. The prognostic significance of functional tests in kryptogenic fibrosing alveolitis.  Bull Europ Physiopath Resp . 1980;  16 711-720
• 56 Stack B H, Choo-Kang Y F, Heard B E. The prognosis of cryptogenic fibrosing alveolitis.  Thorax . 1972;  27 535-542
• 57 Johnson M A, Kwan S, Snell N J. Randomised controlled trial comparing prednisolone alone with cyclophosphamide and low dose prednisolone in combination in cryptogenic fibrosing alveolitis.  Thorax . 1989;  44 280-288
• 58 Raghu G, Mageto Y N, Lockhart D. The accuracy of the clinical diagnosis of new-onset idiopathic pulmonary fibrosis and other interstitial lung disease: a prospective study.  Chest . 1999;  116 1168-1174
• 59 Flaherty K R, Toews G B, Lynch III P J. Steroids in idiopathic pulmonary fibrosis: a prospective assessment of adverse reactions, response to therapy, and survival.  Am J Med . 2001;  110 278-282
• 60 Nagai S, Kitaichi M, Hamada K. Hospital-based historical cohort study of 234 histologically proven Japanese patients with IPF.  Sarcoidosis Vasc Diffuse Lung Dis . 1999;  16 209-214
• 61 Watters L C, King T E, Schwarz M I. A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis.  Am Rev Respir Dis . 1986;  133 97-103
• 62 Watters L C, Schwarz M I, Cherniack R M. Idiopathic pulmonary fibrosis: pretreatment bronchoalveolar lavage cellular constituents and their relationships with lung histopathology and clinical response to therapy.  Am Rev Respir Dis . 1987;  135 696-704
• 63 Turner-Warwick M, Haslam P L. The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis.  Am Rev Respir Dis . 1987;  135 26-34
• 64 Watters L C, King T E, Schwarz M I. A clinical, radiographic, and physiologic scoring system for the longitudinal assessment of patients with idiopathic pulmonary fibrosis.  Am Rev Respir Dis . 1986;  133 97-103
• 65 Hansen J E, Wasserman K. Pathophysiology of activity limitation in patients with interstitial lung disease.  Chest . 1996;  109 1566-1576
• 66 Wells A U, Rubens M B, du Bois M R. Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern.  Am J Roentgenol . 1993;  161 1159-1165
• 67 Hartman T E, Primack S L, Swensen S J. Desquamative interstitial pneumonia: thin-section CT findings in 22 patients.  Radiology . 1993;  187 787-790
• 68 Wells A U, Cullinan P, Hansell D M. Fibrosing alveolitis associated with systemic sclerosis has a better prognosis than lone cryptogenic fibrosing alveolitis.  Am J Respir Crit Care Med . 1994;  149 1583-1590
• 69 Remy-Jardin M, Remy J, Wallaert B. Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage.  Radiology . 1993;  189 111-118
• 70 Lee J S, Im J G, Ahn J M. Fibrosing alveolitis: prognostic implication of ground-glass attenuation at high-resolution CT.  Radiology . 1992;  184 451-454
• 71 Wells A U, Hansell D M, Rubens M B. Functional impairment in lone cryptogenic fibrosing alveolitis and fibrosing alveolitis associated with systemic sclerosis: a comparison.  Am J Respir Crit Care Med . 1997;  155 1657-1664
• 72 Wells A. Clinical usefulness of high resolution computed tomography in cryptogenic fibrosing alveolitis.  Thorax . 1998;  53 1080-1087
• 73 Akira M, Sakatani M, Ueda E. Idiopathic pulmonary fibrosis: progression of honeycombing at thin-section CT.  Radiology . 1993;  189 687-691
• 74 Kazerooni E A, Martinez F J, Flint A. Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring.  Am J Roentgenol . 1997;  169 977-983
• 75 Terriff B A, Kwan S Y, Chan-Yeung M M. Fibrosing alveolitis: chest radiography and CT as predictors of clinical and functional impairment at follow-up in 26 patients.  Radiology . 1992;  184 445-449
• 76 Mogulkoc N, Brutsche M H, Bishop P W. Pulmonary function in idiopathic pulmonary fibrosis and referral for lung transplantation.  Am J Respir Crit Care Med . 2001;  164 103-108
• 77 Flume P A, Egan T M, Westerman J H. Lung transplantation for mechanically ventilated patients.  J Heart Lung Transplant . 1994;  13 15-23
• 78 Stern J B, Mal H, Groussard O. Prognosis of patients with advanced idiopathic pulmonary fibrosis requiring mechanical ventilation for acute respiratory failure.  Chest . 2001;  120 213-219
• 79 Hartman T E, Primack S L, Kang E Y. Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia: assessment with serial CT.  Chest . 1996;  110 378-382
• 80 Yousem S A, Colby T V, Gaensler E A. Respiratory bronchiolitis-associated interstitial lung disease and its relationship to desquamative interstitial pneumonia.  Mayo Clin Proc . 1989;  64 1373-1380
• 81 Myers J L, Veal C F, Shin M S. Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of six cases.  Am Rev Respir Dis . 1987;  135 880-884
• 82 Moon J, DuBois R M, Colby T V. Clinical significance of respiratory bronchiolitis on open lung biopsy and its relationship to smoking related interstitial lung disease.  Thorax . 1999;  54 1009-1014
• 83 Heyneman L, Ward S, Lynch D A. Respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process.  Am J Roentgenol . 1999;  173 1617-1622
• 84 Alasaly K, Muller N, Ostrow D N. Cryptogenic organizing pneumonia: a report of 25 cases and a review of the literature.  Medicine (Baltimore) . 1995;  74 201-211
• 85 Lazor R, Vandevenne A, Pelletier A. Cryptogenic organizing pneumonia: characteristics of relapses in a series of 48 patients.  Am J Respir Crit Care Med . 2000;  162 571-577
• 86 Katzenstein A LA, Fiorelli R F. Nonspecific interstitial pneumonia/fibrosis: histologic features and clinical significance.  Am J Surg Pathol . 1994;  18 136-147
• 87 Hartman T E, Swensen S J, Hansell D M. Nonspecific interstitial pneumonia: variable appearance at high-resolution chest CT.  Radiology . 2000;  217 701-705
• 88 Nishiyama O, Kondoh Y, Taniguchi H. Serial high resolution CT findings in nonspecific interstitial pneumonia/ fibrosis.  J Comput Assist Tomogr . 2000;  24 41-46
• 89 Akira M, Inoue G, Yamamoto S. Nonspecific interstitial pneumonia: findings on sequential CT scans of nine patients.  Thorax . 2000;  55 854-859
• 90 Lynch III J P, Orens J, Kazerooni E A. Collagen vascular diseases. In: Sperber M, ed. Diffuse Lung Diseases: A Comprehensive Clinical-Radiological Overview London: Springer-Verlag 1999: 325-355
• 91 Levine S M, Anzueto A, Peters J I. Single lung transplantation in patients with systemic disease.  Chest . 1994;  105 837-841
• 92 Pigula F A, Griffith B P, Zenati M A. Lung transplantation for respiratory failure resulting from systemic disease.  Ann Thorac Surg . 1997;  64 1630-1634
• 93 Bulpitt K J, Clements P J, Lachenbruch P A. Early undifferentiated connective tissue disease III: Outcome prognostic indicators in early scleroderma (systemic sclerosis).  Ann Intern Med . 1993;  118 602-609
• 94 D'Angelo W A, Fries F J, Masi A T. Pathologic observations in systemic sclerosis (scleroderma): a study of fifty-eight autopsy cases and fifty-eight matched controls.  Am J Med . 1969;  46 428-440
• 95 Weaver A L, Divertie M B, Titus J L. Pulmonary scleroderma.  Dis Chest . 1968;  54 490-498
• 96 Owens G R, Sciurba F C, Rogers R M. DL_co in COPD.  Chest . 1988;  94 897-898
• 97 King T E. Interstitial Lung Disease. 3rd ed. London: BC Decker Inc, Hamilton 1998
• 98 Lynch III P J, Flint A, Belperio J. Bronchiolar complications of connective tissue disorders.  Semin Respir Crit Care Med . 1999;  20 149-168
• 99 Witt C, Borges A C, John M. Pulmonary involvement in diffuse cutaneous systemic sclerosis: bronchoalveolar fluid granulocytosis predicts progression of fibrosing alveolitis.  Ann Rheum Dis . 1999;  58 635-640
• 100 Alhamad E H, Lynch III P J, Martinez F J. Pulmonary function testing in interstitial lung disease: what role do they have?.  Clin Chest Med. In press.
• 101 Peters-Golden M, Wise R A, Hochberg M C. Carbon monoxide diffusing capacity as predictor of outcome in systemic sclerosis.  Am J Med . 1984;  77 1027-1034
• 102 Silver R M, Miller K S. Lung involvement in systemic sclerosis.  Rheum Dis Clin North Am . 1990;  16 199-216
• 103 Steen V D, Lanz Jr K J, Conte C. Therapy for severe interstitial lung disease in systemic sclerosis: a retrospective study.  Arthritis Rheum . 1994;  37 1290-1296
• 104 Medsger Jr A T, Silman A J, Steen V D. A disease severity scale for systemic sclerosis: development and testing.  J Rheumatol . 1999;  26 2159-2167
• 105 Greenwald G I, Tashkin D P, Gong H. Longitudinal changes in lung function and respiratory symptoms in progressive systemic sclerosis: prospective study.  Am J Med . 1987;  83 83-92
• 106 Jacobsen S, Halberg P, Ullman S. A longitudinal study of pulmonary function in Danish patients with systemic sclerosis.  Clin Rheum . 1997;  16 384-390
• 107 Wells A U, Hansell D M, Rubens M B. The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis.  Am Rev Respir Dis . 1993;  148 1076-1082
• 108 Akesson A, Scheja A, Lundin A. Improved pulmonary function in systemic sclerosis after treatment with cyclophosphamide.  Arthritis Rheum . 1994;  37 729-735
• 109 White B, Moore W C, Wigley F M. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma alveolitis.  Ann Intern Med . 2000;  132 947-954
• 110 Cronin M E, Plotz P H. Idiopathic inflammatory myopathies.  Rheum Dis Clin North Am . 1990;  16 655-665
• 111 Marie I, Hatron P Y, Hachulla E. Pulmonary involvement in polymyositis and in dermatomyositis.  J Rheumatol . 1998;  25 1336-1343
• 112 Lakhanpal S, Lie J T, Conn D L. Pulmonary disease in polymyositis/dermatomyositis: a clinicopathological analysis of 65 autopsy cases.  Ann Rheum Dis . 1987;  46 23-29
• 113 Tazelaar H D, Viggiano R W, Pickersgill J. Interstitial lung disease in polymyositis and dermatomyositis: clinical features and prognosis as correlated with histologic findings.  Am Rev Respir Dis . 1990;  141 727-733
• 114 Marguerie C, Bunn C C, Beynon H L. Polymyositis, pulmonary fibrosis and autoantibodies to aminoacyl-tRNA synthetase enzymes.  Q J Med . 1990;  77 1019-1038
• 115 Targoff I N, Arnett F C, Berman L. Anti-KJ: a new antibody associated with the syndrome of polymyositis and interstitial lung disease.  J Clin Invest . 1989;  84 162-172
• 116 Arsura E L, Greenberg A S. Adverse impact of interstitial pulmonary fibrosis on prognosis in polymyositis and dermatomyositis.  Semin Arthritis Rheum . 1988;  18 29-37
• 117 Dalakas M C. Polymyositis, dermatomyositis, and inclusion body myositis.  N Engl J Med . 1991;  325 1487-1498
• 118 Mino M, Noma S, Taguchi Y. Pulmonary involvement in polymyositis and dermatomyositis: sequential evaluation with CT.  Am J Roentgenol . 1997;  169 83-87
• 119 Saag K G, Kolluri S, Koehnke R K. Rheumatoid arthritis lung disease: determinants of radiographic and physiologic abnormalities.  Arthritis Rheum . 1996;  39 1711-1719
• 120 Cortet B, Perez T, Roux N. Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis.  Ann Rheum Dis . 1997;  56 596-600
• 121 Dawson J K, Fewins H E, Desmond J. Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography and chest radiography, and pulmonary function tests.  Thorax . 2001;  56 622-627
• 122 Banks J, Banks C, Cheong B. An epidemiological and clinical investigation of pulmonary function and respiratory symptoms in patients with rheumatoid arthritis.  Q J Med . 1992;  85 307-308
• 123 Anaya J M, Diethelm L, Ortiz L A. Pulmonary involvement in rheumatoid arthritis.  Semin Arthritis Rheum . 1995;  24 242-254
• 124 Gabbay E, Tarala R, Will R. Interstitial lung disease in recent onset rheumatoid arthritis.  Am J Respir Crit Care Med . 1997;  156 528-535
• 125 Roschmann R A, Rothenberg R J. Pulmonary fibrosis in rheumatoid arthritis: a review of clinical features and therapy.  Semin Arthritis Rheum . 1987;  16 174-185
• 126 McDonagh J, Greaves M, Wright A R. High resolution computed tomography of the lungs in patients with rheumatoid arthritis and interstitial lung disease.  Br J Rheumatol . 1994;  33 118-122
• 127 Fujii M, Adachi S, Shimizu T. Interstitial lung disease in rheumatoid arthritis: assessment with high-resolution computed tomography.  J Thorac Imaging . 1993;  8 54-62
• 128 Remy-Jardin M, Remy J, Cortet B. Lung changes in rheumatoid arthritis: CT findings.  Radiology . 1994;  193 375-382
• 129 Linstow M, Ulrik C S, Kriegbaum N J. An 8-year follow-up study of pulmonary functon in patients with rheumatoid arthritis.  Rheumatol Int . 1994;  14 115-118
• 130 Dayton C S, Schwartz D A, Sprince N L. Low-dose methotrexate may cause air trapping in patients with rheumatoid arthritis.  Am J Respir Crit Care Med . 1995;  151 1189-1193
• 131 Haerden J, Coolen L, Dequeker J. The effect of D-penicillamine on lung function parameters (diffusing capacity) in rheumatoid arthritis.  Clin Exp Rheumatol . 1993;  11 509-513
• 132 Hakala M. Poor prognosis in patients with rheumatoid arthritis hospitalized for interstitial lung fibrosis.  Chest . 1988;  93 114-118
• 133 Gilligan D M, O'Connor C M, Ward K. Bronchoalveolar lavage in patients with mild and severe rheumatoid lung disease.  Thorax . 1990;  45 591-596
• 134 Tishler M, Grief J, Fireman E. Bronchoalveolar lavage: a sensitive test for early diagnosis of pulmonary involvement in rheumatoid arthritis.  J Rheumatol . 1986;  13 547-550
• 135 Walaert B, Hatron P Y, Grosbois J-M. Subclinical pulmonary involvement in collagen vascular diseases assessed by bronchoalveolar lavage.  Am Rev Respir Dis . 1986;  133 574-580
• 136 Weinrib L, Sharma O P, Quismorio F P. A long-term study of interstitial lung disease in systemic lupus erythematosus.  Semin Arthritis Rheum . 1990;  20 48-56
• 137 Todd N W, Wise R A. Respiratory complications in the collagen vascular diseases.  Clin Pulm Med . 1996;  3 101-112
• 138 Orens J B, Martinez F J, Lynch J P. Pleuropulmonary manifestations of systemic lupus erythematosus.  Rheum Dis Clin North Am . 1994;  20 159-193
• 139 Haupt H M, Moore G W, Hutchins G M. The lung in systemic lupus erythematosus: analysis of the pathologic changes in 120 patients.  Am J Med . 1981;  71 791-798
• 140 Fenlon H M, Doran M, Sant S M. High-resolution chest CT in systemic lupus erythematosus.  Am J Roentgenol . 1996;  166 301-307
• 141 Groen H, ter Borg E J, Postma E J. Pulmonary function in systemic lupus erthematosus is related to distinct clinical and serologic and nailfold capillary patterns.  Am J Med . 1992;  93 619-627
• 142 Sharp G E, Irving W, Tan E. Mixed connective tissue disease: an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA).  Am J Med . 1972;  52 148-159
• 143 Sullivan W D, Hurst D J, Harmon C E. A prospective evaluation emphasizing pulmonary involvement in patients with mixed connective tissue disease.  Medicine (Baltimore) . 1984;  63 92-107
• 144 Moutsopoulos H M, Chused T M, Mann D L. Sjogren's syndrome (Sicca Syndrome): Current Issues.  Ann Int Med . 1980;  92 212-226
• 145 Deheinzelin D, Capelozzi V L, Kairalla R A. Interstitial lung disease in primary Sjogren's syndrome: clinical-pathological evaluation and response to treatment.  Am J Respir Crit Care Med . 1996;  154 794-799
• 146 Constantopoulos S, Papadimitriou C S, Moutsopoulos H M. Respiratory manifestations in primary Sjogren's syndrome: a clinical, functional and histologic study.  Chest . 1985;  88 226-229
• 147 Pigula F A, Griffith B P, Zenati M A. Lung transplantation for respiratory failure resulting from systemic disease.  Ann Thorac Surg . 1997;  64 1630-1634
• 148 De Vuyst P, Camus P. The past and present of pneumoconioses.  Curr Opin Pulm Med . 2000;  6 151-156
• 149 Nemery B, Verbeken E K, Demedts M. Giant cell interstitial pneumonia (hard metal lung disease and cobalt lung).  Semin Respir Crit Care Med . 2001;  22 435-447
• 150 Frost A E, Keller C A, Brown R W. Giant cell interstitial pneumonitis: disease recurrence in the transplanted lung.  Am Rev Respir Dis . 1993;  148 1401-1404
• 151 Single lung transplantation for end-stage silicosis: report of a case. Lung Transplant Group.  J Formos Med Assoc . 1992;  91 926-932
• 152 Santamauro J T, Stover D E, Jules-Elysee K. Lung transplantation for chemotherapy-induced pulmonary fibrosis.  Chest . 1994;  105 310-312
• 153 Sequential bilateral lung transplantation for paraquat poisoning: a case report. Toronto Lung Transplant group.  J Thorac Cardiovasc Surg . 1985;  89 734-742
• 154 Luh S P, Lee Y C, Chang Y L. Lung transplantation for patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome.  Clin Transplant . 1999;  13 496-503
• 155 Boas S R, Noyes B E, Kurland G. Pediatric lung transplantation for graft-versus-host disease following bone marrow transplantation.  Chest . 1994;  105 1584-1586
• 156 Calhoon J H, Levine S, Anzueto A. Lung transplantation in a patient with a prior bone marrow transplant.  Chest . 1992;  102 948
• 157 Novick R J, Stitt L W, Al-Kattan K. Pulmonary retransplantation: predictors of graft function and survival in 230 patients. Pulmonary Retransplant Registry.  Ann Thorac Surg . 1998;  65 227-234