HP is a severe lung disease with a poor prognosis due to the development of respiratory failure. Lung transplantation (LTx) may be an option in cases of clinical deterioration and poor quality of life. However, the published experience is limited.
Our objective was to evaluate the clinical characteristics and survival of patients with LTx due to HP, so we made a retrospective study at Puerta del Hierro University Hospital of patients with LTx due to fibrotic HP from  01/2010 to 11/2022.

Results: 29 of the 529 LTx (5.5%) were due to fibrotic HP. The mean age was 55 years, 52% were women and 48% came from Canary Islands.

HP was diagnosed by videothoracoscopy lung biopsy in 48% of cases. The precipitins were positive in only 25% of the patients (67% pigeons, 17% other birds and fungi). 62% of the cases received treatment with steroids and 21% also with immunosuppressants.

48% were smokers, 61% overweight (BMI:25-30), 30% arterial hypertension and 28% dyslipidemia.
Mean pre-LTx FVC was 1442 ml (42%), VEMS 1276 ml (43%), DLCO 31% and T6MW 353m. 24% of the patients developed pulmonary hypertension.

92% of the LTx were bipulmonary and 24% were national emergency. 

31% presented early acute cellular rejection, the most frequent grades were A1-A2.
14% developed chronic graft dysfunction (75% BOS).
7 patients died; 4 due to postoperative complications (primary graft dysfunction and hemothorax)2 for COVID and 1 due to septic shock at 7 years post-LTx.

Survival of patients transplanted for NH at 1 year was 86% and at 5 years 79%.

Conclusion: HP is a serious disease that may benefit from LTx in selected patients and it has a superior long-term survival post-Ltx compared to other interstitital lung disease.