Long-Term Outcome of Lung and Heart-Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension

doi:10.1016/j.athoracsur.2008.05.049

The Annals of Thoracic Surgery

Volume 86, Issue 4, October 2008, Pages 1116-1122

https://doi.org/10.1016/j.athoracsur.2008.05.049 Get rights and content

Background

The survival after lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension has been reportedly the lowest among the major diagnostic categories of lung transplant recipients.

Methods

Retrospective analysis was performed for lung and heart-lung transplant recipients for idiopathic pulmonary arterial hypertension from 1982 to 2006. The patients were divided into 2 groups, based on the era; group 1: 1982 to 1993, and group 2: 1994 to 2006. Since 1994, we have introduced our current protocols including prostaglandin E₁ and nitroglycerin for donor lung preservation, and lung protection with cold and terminal warm blood pneumoplegia as well as immunosuppression with alemtuzumab induction. These modifications were introduced in different years over a wide span of time (1994 to 2003).

Results

Group 1 had 59 patients (35 ± 1 years old, ranging 15 to 53, 20 male and 39 female) with 7 single lung, 11 double lung, and 41 heart-lung, whereas group 2 had 30 (43 ± 2 years old, ranging 17 to 65, 9 male and 21 female) with 2 single, 20 double, and 8 heart-lung transplantations. The recipient age was significantly (p = 0.004) higher in group 2, and group 2 had significantly older (35 ± 3 vs 26 ± 1, p = 0.002) and more female donors (73% vs 41%, p = 0.007) compared with group 1. The actuarial survival was significantly (p = 0.004) better in group 2 with 86% at 1 year, 75% at 5 years, and 66% at 10 years compared with group 1 with 58% at 1 year, 39% at 5 years, and 27% at 10 years.

Conclusions

With our current pulmonary protection and immunosuppression, the long-term outcome of lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension is excellent.

Section snippets

Patients and Methods

The University of Pittsburgh Medical Center (UPMC) lung and heart-lung transplant evaluation and recipient research registry is approved by the University of Pittsburgh Institutional Review Board for the use of patient management, quality assurance reports, and clinical research. Individual consent to act as a subject in a research study was obtained for each patient. Data were prospectively collected into the Web-based Transplant Patient Management System, and the data were retrospectively

Long-Term Outcome From 1982 to 2006

From May of 1982 to September of 2006, 949 patients received lung and heart-lung transplants including 444 single lung, 384 double lung, and 121 combined heart-lung transplants at UPMC Presbyterian Hospital. Idiopathic pulmonary arterial hypertension was the indication for lung and heart-lung transplantation in 10% of our recipients, but IPAH was the most common indication for combined heart-lung transplantation in 45% of our heart-lung transplant recipients. Eighty-nine patients underwent lung

Comment

The 23rd official report from the registry of the ISHLT shows that IPAH had the highest perioperative mortality rate among the major diagnostic categories of lung transplant recipients, the lowest survival rate at 1 year, and the second lowest at 5 years [2]. This suggests that the outcome of lung and heart-lung transplantation for IPAH has been suboptimal, and because of that and possibly due to recent advancement of medical treatment for pulmonary artery hypertension, it is possible that

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Original articleGeneral thoracicLong-Term Outcome of Lung and Heart-Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Long-Term Outcome From 1982 to 2006

Comment

Clin Chest Med

J Heart Lung Transplant

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Heart Lung Transplant

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Original article
General thoracic
Long-Term Outcome of Lung and Heart-Lung Transplantation for Idiopathic Pulmonary Arterial Hypertension