Long-term outcome of double-lung and heart-lung transplantation for pulmonary hypertension: a comparative retrospective study of 219 patients.

Abstract

OBJECTIVE:

Whether double-lung transplantation (DLT) or heart-lung transplantation (HLT) is the best option in patients with pulmonary hypertension (PH) remains unclear. At our institution, patients with severe right ventricular dysfunction or congenital systemic-to-pulmonary shunt (CSPS) are preferentially treated with HLT. We sought to determine whether the outcomes warrant continuing this policy.

METHODS:

We retrospectively reviewed cases of DLT (n=67) or HLT (n=152) performed for end-stage PH between 1986 and 2008 at our institution. According to the new clinical classification of PH, 147 patients were group I (pulmonary arterial hypertension group, of which 30 had CSPS), 24 were group III (PH associated with lung disease and/or hypoxaemia), 20 were group IV (chronic thrombo-embolic PH) and 20 were group V (sarcoidosis or histiocytosis X).

RESULTS:

Compared with the HLT group, the DLT group had less severe disease as reflected by a higher preoperative cardiac index (2.5 + or - 0.8 vs 2.0 + or - 0.4; P=0.0006), lower New York Heart Association (NYHA) functional class (3.4 + or - 0.4 vs 3.8 + or - 0.5; P<0.0001), lower rates of kidney failure (31% vs 66%; P<0.0001) and liver failure (13% vs 38%; P=0.0003) and less need for preoperative inotropic support (10% vs 25%; P=0.014). Nevertheless, survival after 1, 5, 10 and 15 years was not significantly different between the two groups (HLT group: 70%, 50%, 39% and 26%; and DLT group: 79%, 52%, 43% and 30%; respectively; P=0.932). Freedom from obliterative bronchiolitis-related death was significantly greater in the HLT group (100% at 1 year, 84% at 5 years and 74% at 10 years; compared with 98%, 70%, and 59%, respectively, in the DLT group; P=0.035).

CONCLUSIONS:

In patients with end-stage PH, good long-term survival rates were obtained using either DLT or HLT. However, these results were achieved with preferential use of HLT in patients with right heart failure or CSPS. Obliterative bronchiolitis-related death was less common with HLT than with DLT.

• Authors: Elie Fadel, Olaf Mercier, Sacha Mussot, François Leroy-Ladurie, Jacques Cerrina, Alain Chapelier, Gérald Simonneau, Philippe Dartevelle
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 38 Issue 3 Pg. 277-84 (Sep 2010) ISSN: 1873-734X [Electronic] Germany
• PMID: 20371187 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Chemical References

• Immunosuppressive Agents

Topics

• Adolescent
• Adult
• Bronchiolitis Obliterans (prevention & control)
• Child
• Epidemiologic Methods
• Female
• Heart Defects, Congenital (complications)
• Heart Failure (complications)
• Heart-Lung Transplantation (methods)
• Humans
• Hypertension, Pulmonary (etiology, surgery)
• Immunosuppressive Agents (therapeutic use)
• Lung Diseases (complications)
• Lung Transplantation (methods)
• Male
• Middle Aged
• Postoperative Care (methods)
• Treatment Outcome
• Ventricular Dysfunction, Right (complications)
• Young Adult