Lung and heart-lung transplant practice patterns in pulmonary hypertension centers.
BACKGROUND
Transplant practice patterns for pulmonary hypertension in the epoprostenol era are unknown.


METHODS
Thirty-five centers in North America, Europe, and Israel were surveyed regarding practice patterns for lung and heart-lung transplant.


RESULTS
New York Heart Association class and distance on a 6-minute walk were considered most useful for deciding who to refer for listing. Patients with New York Heart Association class I to II were referred for listing in 26% of centers, while 57% were classified as New York Heart Association class III or greater after epoprostenol failure. Twenty-nine of the 35 centers had transplant programs that performed approximately 75% of the International Registry volume annually. A double lung transplant was preferred by 83% of centers and heart-lung transplant in the remaining centers. The wait time for lung transplant averaged 16.8 months (range 4-36) and for heart-lung transplant averaged 21.3 months (range 6-36) and was significantly longer in the United States. The mean maximum age for heart-lung transplant was 51.4 years (range 35-65), double lung transplant 58.3 years (range 45-65), and single lung transplant 63.1 years (range 50-70). Fifty-three percent of centers transplant New York Heart Association class III or IV patients, 26% class IIIb-IV, and 21% only class IV. Eighty percent of centers use a transplant hold status. Major unqualified exclusions were hepatitis in 38%, 1 or more hepatic (90%) or renal (100%) criteria, smoking 97%, and obesity in 93%.


CONCLUSIONS
Physicians and patients should be aware of the considerable variability in practice patterns for transplantation in pulmonary hypertension, despite published guidelines.
Pielsticker
E J
EJ
Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor 48106-0363, USA.
Martinez
F J
FJ
Rubenfire
M
M
D000328:Adult; D000368:Aged; D002170:Canada; D000075202:Contraindications; D003431:Cross-Cultural Comparison; D005060:Europe; D005260:Female; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000601:surgery*; D007557:Israel; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015996:Survival Rate; D014481:United States