Long-term outcome of double-lung and heart-lung transplantation for pulmonary hypertension: a comparative retrospective study of 219 patients.
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.
Fadel
Elie
E
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, Paris-Sud University, Paris, France. fadel@ccml.com
Mercier
Olaf
O
Mussot
Sacha
S
Leroy-Ladurie
François
F
Cerrina
Jacques
J
Chapelier
Alain
A
Simonneau
Gérald
G
Dartevelle
Philippe
P
D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000517:prevention & control; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000150:complications; D016041:Heart-Lung Transplantation / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000150:complications; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications; D055815:Young Adult
D007166:Immunosuppressive Agents