title: Heart-lung vs. double-lung transplantation for idiopathic pulmonary arterial hypertension.
abstract: Patients with idiopathic pulmonary arterial hypertension (IPAH) have improved survival after heart-lung transplantation (HLT) and double-lung transplantation (DLT). However, the optimal procedure for patients with IPAH undergoing transplantation remains unclear. We hypothesized that critically ill IPAH patients, defined by admission to the intensive care units (ICU), would demonstrate improved survival with HLT vs. DLT. All adult IPAH patients (>18 yr) in the Scientific Registry of Transplant Recipients (SRTR) database, who underwent either HLT or DLT between 1987 and 2012, were included. Baseline characteristics, survival, and adjusted survival were compared between the HLT and DLT groups. Similar analyses were performed for the subgroups as defined by the recipients' hospitalization status. A total of 928 IPAH patients (667 DLT, 261 HLT) were included in this analysis. The HLT recipients were younger, more likely to be admitted to the ICU, and have had their transplant in previous eras. Overall, the adjusted survivals after HLT or DLT were similar. For recipients who were hospitalized in the ICU, DLT was associated with worse outcomes (HR 1.827; 95% CI 1.018-3.279). In IPAH patients, the overall survival after HLT or DLT is comparable. HLT may provide improved outcomes in critically ill IPAH patients admitted to the ICU at time of transplantation.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Hill
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Maxwell
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris-Sud University, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Boulate
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ha
authors.affiliation: Keck School of Medicine, USC, Los Angeles, CA, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Afshar
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Weill
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Gundeep S
authors.initials: GS
authors.lastname: Dhillon
mesh_terms: D000328:Adult; D065627:Familial Primary Pulmonary Hypertension / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016041:Heart-Lung Transplantation; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate
keywords: Scientific Registry of Transplant Recipients Database; double-lung transplantation; heart-lung transplantation; idiopathic pulmonary arterial hypertension; pulmonary arterial hypertension