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Lung transplantation for pulmonary vascular disease.

AbstractBACKGROUND:
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.
AuthorsEric 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
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 73 Issue 1 Pg. 209-17; discussion 217-9 (Jan 2002) ISSN: 0003-4975 [Print] Netherlands
PMID11834012 (Publication Type: Journal Article)
Chemical References
  • Immunosuppressive Agents
  • Cyclosporine
Topics
  • Adolescent
  • Adult
  • Bronchiolitis Obliterans (surgery)
  • Child
  • Child, Preschool
  • Cyclosporine (administration & dosage)
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary (surgery)
  • Immunosuppressive Agents (administration & dosage)
  • Infant
  • Lung Transplantation (methods, mortality)
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis

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