Original article: general thoracic
Lung transplantation for pulmonary vascular disease

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
https://doi.org/10.1016/S0003-4975(01)03082-XGet rights and content

Abstract

Background. Pulmonary hypertension (PHT) is a lethal condition resulting in markedly diminished life expectancy. Continuous prostaglandin I2 infusion has made an important contribution to symptom management, but it is not a panacea. Lung or heart-lung transplantation remains an important treatment option for end-stage PHT patients unresponsive to prostaglandin I2. This study reviews the outcomes after transplantation for PHT in our program.

Methods. A retrospective chart review was performed for 100 consecutive patients with either primary PHT (48%) or secondary PHT (52%) transplants since 1989. Living recipients were contacted to confirm health and functional status.

Results. Fifty-five adult and 45 pediatric patients underwent 51 bilateral lung transplants, 39 single lung transplants, and 10 heart-lung transplants. Mean age was 23.7 years (range, 1.2 months to 54.8 years) and mean pre-transplant New York Heart Association class was 3.2. Pre-transplant hemodynamics revealed a mean right atrial pressure of 9.6 ± 5.4 mm Hg and mean pulmonary artery pressure of 64 ± 14.4 mm Hg. Hospital mortality was 17% with early death predominantly because of graft failure and infection. With an average follow-up of 5.0 years, 1- and 5-year actuarial survival was 75% and 57%, respectively. Mean pulmonary artery pressure on follow-up catheterization was 22 ± 6.0 mm Hg, and mean follow-up New York Heart Association class was 1.3 (p < 0.001 for both compared with pre-transplant). Diagnosis and type of transplant did not confer a significant difference in survival between groups.

Conclusions. Whereas lung or heart-lung transplant for PHT is associated with higher early mortality than other pulmonary disease entities, it provides similar long-term outcomes with dramatic improvement in both quality of life and physiologic aspects.

Section snippets

Patient population

Since November of 1989, 668 patients have undergone HLT, BLT, or SLT at our combined hospitals for adults (Barnes-Jewish Hospital, St. Louis, MO) and children (St. Louis Children’s Hospital, St. Louis, MO). One hundred transplants were performed in patients with PPH or PHT associated with a congenital heart defect. The pediatric population is defined as those under the age of 18 years at the time of transplantation. The current study focuses on 55 adult and 45 pediatric patients who had 51

Patient population

One hundred consecutive patients with primary or secondary PHT associated with a congenital heart defect underwent SLT, BLT, or HLT during a 10-year period. Follow-up was complete in all patients through December 31, 2000. The average length of follow-up was 5 years. The mean age was 23.7 years with a range from 1.2 months to 54.8 years. Because all of the single lung transplants were performed in adults and the majority of the BLTs and HLTs were done in the pediatric group, the SLT group as a

Comment

This study was undertaken in order to review a large, single institution experience with transplantation for PHT. When to commit a patient to lung transplantation for pulmonary vascular disease is not necessarily a straightforward decision. In recent years, making this decision has been a moving target as a result of significant advances in medical intervention that included graded balloon dilation atrial septostomy and continuous prostacyclin infusion 3, 4, 14, 15. Further, an important

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