Background: Lung transplant is increasingly offered for severe cardiopulmonary disease in autoimmune rheumatic diseases (ARDs). Patients frequently have extrapulmonary manifestations requiring immunosuppression, but how this affects clinical trajectory post-transplant is unclear.

Objectives: Our study objectives were to compare complications post-transplant in people with and without ARDs; and in people with ARDs with and without transplant.

Methods: All lung/heart-and-lung transplants performed in British Columbia from 01/01/1990 to 01/01/2022 were identified using administrative health data. Transplants with ARD were matched ≥1:10 (propensity score matching with replacement) on age, sex, transplant-year, previous disease modifying anti-rheumatic drugs (DMARD)/biologic use, socioeconomic status, and ARD, generating a) ARD-controls and b) transplant-controls. Mortality, major adverse cardiovascular events (MACE) and infections were compared and DMARD use post-transplant quantified. Statistical modelling applied multivariable Cox proportional and Fine-Gray sub-distribution hazards and Poisson regression.

Results: Cohorts comprised n=85 ARD-transplants; n=42,062 ARD-controls; and n=3,412 transplant-controls. ARD-transplant patients had increased mortality compared with transplant-controls and ARD controls (IR 112.6 vs 58.6 and 11.3 respectively). However, in multivariable regression analyses, risk of mortality, MACE, and infection were comparable between transplant cohorts, but were higher in ARD-transplant vs. ARD-controls. Rheumatoid arthritis (RA)-transplants had higher risk of MACE than RA-controls (HR 5.07 95% CI 1.67, 15.41) which was not seen for other ARDs. 90% of ARD-transplant remained on pre-transplant DMARDS. Those stopping DMARDs had lower infection risk (HR 0.25 95% CI 0.14, 0.44) but paradoxically increased mortality (HR 10.87 95% CI 3.89, 30.44).

Conclusion: Reassuringly, when adjusting for comorbidities and patient characteristics, lung transplants with and without concurrent ARD had similar mortality, MACE, and infection risk. Future multi-centre studies are needed to better understand the impact of DMARD class post-transplant.

REFERENCES: NIL.

Acknowledgements: We would like to acknowledge John Esdaile for his support and guidance. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.