Impact of flat chest on waitlist mortality in adult patients with pleuroparenchymal fibroelastosis listed for lung transplantation

Background: Pleuroparenchymal fibroelastosis (PPFE) is a distinct subtype of idiopathic interstitial pneumonia, and progressive cases require lung transplantation (LT). Some patients with PPFE develop chest flattening; however, its impact on waitlist mortality for LT remains unclear. Methods: We retrospectively analyzed adult patients with PPFE listed for LT from donation after brain death (DBD) between January 2014 and July 2024. Chest flatness was quantified as the ratio of the anteroposterior diameter of the thoracic cage to its transverse diameter (APDT/TDT). An APDT/TDT cut-off for waitlist mortality was determined by receiver operating characteristic curve analysis. The primary objective was to investigate the prognostic significance of APDT/TDT on waitlist mortality. Results: = 0.007) as risk factors for waitlist mortality. Conclusions: The APDT /TDT, an index of a flat chest, may serve as a prognostic factor for waitlist mortality in patients with PPFE awaiting LT.