Transplantation for idiopathic pulmonary arterial hypertension: improvement in the lung allocation score era.

Abstract

BACKGROUND:

Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poorly described.

METHODS AND RESULTS:

Adults diagnosed with idiopathic pulmonary arterial hypertension and listed for transplantation in the 80 months before and after the lung allocation score algorithm was implemented (n=1430) were identified in the United Network for Organ Sharing thoracic registry. Patients were stratified by organ listed and pre- and post-lung allocation score era. The cumulative incidences of transplantation and mortality for wait-listed patients in both eras were appraised with competing outcomes analysis. Posttransplantation survival was assessed with the Kaplan-Meier method. These analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of prelisting and pretransplantation characteristics on mortality. We found that patients in the post-lung allocation score era had significantly worse comorbidities; nevertheless, both lung transplantation and heart-lung transplantation candidates in this era enjoyed lower wait-list mortality and a higher incidence of transplantation in unmatched and propensity-matched analyses. On multivariable analysis, heart-lung transplantation and double-lung transplantation were associated with improved survival from the time of wait-listing, as was being listed at a medium- to high-volume institution. Donor/recipient sex matching predicted posttransplantation survival.

CONCLUSIONS:

The incidence of transplantation has increased while wait-list mortality has decreased in patients with idiopathic pulmonary arterial hypertension wait-listed for transplantation in the post-lung allocation score era. Both heart-lung transplantation and double-lung transplantation are predictive of survival in transplantation candidates with idiopathic pulmonary arterial hypertension, as is being listed at a medium- to high-volume institution. Donor/recipient sex matching is associated with better posttransplantation survival.

• Authors: Justin M Schaffer, Steve K Singh, David L Joyce, Bruce A Reitz, Robert C Robbins, Roham T Zamanian, Hari R Mallidi
• Journal: Circulation (Circulation) Vol. 127 Issue 25 Pg. 2503-13 (Jun 25 2013) ISSN: 1524-4539 [Electronic] United States
• PMID: 23697910 (Publication Type: Journal Article)

Topics

• Adult
• Algorithms
• Familial Primary Pulmonary Hypertension
• Female
• Health Care Rationing (trends)
• Heart Transplantation (statistics & numerical data)
• Humans
• Hypertension, Pulmonary (mortality, surgery)
• Incidence
• Kaplan-Meier Estimate
• Lung Transplantation (statistics & numerical data)
• Male
• Middle Aged
• Proportional Hazards Models
• Registries
• Retrospective Studies
• Survival Rate
• Time Factors
• Tissue and Organ Procurement (methods)
• Treatment Outcome
• Waiting Lists (mortality)