|
Title
|
|
|
|
Double-lung versus heart-lung transplantation for precapillary pulmonary arterial hypertension : a 24-year single-center retrospective study
| |
|
Author
|
|
|
|
| |
|
Abstract
|
|
|
|
| Transplant type for end-stage pulmonary vascular disease remains debatable. We compared recipient outcome after heart-lung (HLT) versus double-lung (DLT) transplantation. Single-center analysis (38 HLT-30 DLT; 1991-2014) for different causes of precapillary pulmonary hypertension (PH): idiopathic (22); heritable (two); drug-induced (nine); hepato-portal (one); connective tissue disease (four); congenital heart disease (CHD) (24); chronic thromboembolic PH (six). HLT decreased from 91.7% [1991-1995] to 21.4% [2010-2014]. Re-intervention for bleeding was higher after HLT; (P = 0.06) while primary graft dysfunction grades 2 and 3 occurred more after DLT; (P < 0.0001). Graft survival at 90 days, 1, 5, 10, and 15 years was 93%, 83%, 70%, 47%, and 35% for DLT vs. 82%, 74%, 61%, 48%, and 30% for HLT, respectively (log-rank P = 0.89). Graft survival improved over time: 100%, 93%, 87%, 72%, and 72% in [2010-2014] vs. 75%, 58%, 42%, 33%, and 33% in [1991-1995], respectively; P = 0.03. No difference in chronic lung allograft dysfunction (CLAD)-free survival was observed: 80% & 28% for DLT vs. 75% & 28% for HLT after 5 and 10 years, respectively; P = 0.49. Primary graft dysfunction in PH patients was lower after HLT compared to DLT. Nonetheless, overall graft and CLAD-free survival were comparable and improved over time with growing experience. DLT remains our preferred procedure for all forms of precapillary PH, except in patients with complex CHD. |
| |
|
Language
|
|
|
|
English
| |
|
Source (journal)
|
|
|
|
Transplant international. - Heidelberg, 1988
| |
|
Publication
|
|
|
|
Heidelberg
:
2019
| |
|
ISSN
|
|
|
|
0934-0874
[print]
1432-2277
[online]
| |
|
DOI
|
|
|
|
10.1111/TRI.13409
| |
|
Volume/pages
|
|
|
|
32
:7
(2019)
, p. 717-729
| |
|
ISI
|
|
|
|
000472770100008
| |
|
Pubmed ID
|
|
|
|
30735591
| |
|
Full text (Publisher's DOI)
|
|
|
|
| |
|