Lung transplantation for pulmonary vascular disease

Eric N. Mendeloff, Bryan F. Meyers, Thoralf M. Sundt, Tracey J. Guthrie, Stuart C. Sweet, Maite De La Morena, Steve Shapiro, David T. Balzer, Elbert P. Trulock, John P. Lynch, Michael K. Pasque, Joel D. Cooper, Charles B. Huddleston, G. Alexander Patterson

Research output: Contribution to journalArticle

74 Scopus citations

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.

Original languageEnglish
Pages (from-to)209-219
Number of pages11
JournalAnnals of Thoracic Surgery
Volume73
Issue number1
DOIs
StatePublished - Jan 1 2002

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