Lung transplantation for pulmonary vascular disease.
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.
Mendeloff
Eric N
EN
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. mendeloffe@msnotes.wustl.edu
Meyers
Bryan F
BF
Sundt
Thoralf M
TM
Guthrie
Tracey J
TJ
Sweet
Stuart C
SC
de la Morena
Maite
M
Shapiro
Steve
S
Balzer
David T
DT
Trulock
Elbert P
EP
Lynch
John P
JP
Pasque
Michael K
MK
Cooper
Joel D
JD
Huddleston
Charles B
CB
Patterson
G Alexander
GA
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D016572:Cyclosporine