Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: A 14-year single-center experience

被引:77
作者
de Perrot, Marc [1 ]
Granton, John T.
McRae, Karen
Pierre, Andrew F.
Singer, Lianne G.
Waddell, Thomas K.
Keshavjee, Shaf
机构
[1] Univ Toronto, Div Thorac Surg, Toronto Gen Hosp, Toronto Lung Transplant Program, Toronto, ON M5G 2C4, Canada
关键词
EXTRACORPOREAL MEMBRANE-OXYGENATION; GASTROESOPHAGEAL-REFLUX; IMPACT; SURVIVAL; BRIDGE; HEART;
D O I
10.1016/j.jtcvs.2011.08.055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To analyze the outcomes of patients with pulmonary arterial hypertension referred for lung transplantation and determine the changes over time. Methods: All patients with pulmonary arterial hypertension referred for lung transplantation in our program from January 1997 to September 2010 were reviewed. Pulmonary arterial hypertension was classified as idiopathic (n = 123) or associated with congenital heart disease (n = 77), connective tissue disease (n = 102), or chronic thromboembolic disease (n = 14). Results: After completing their assessment, 61 patients (19%) were found to be unsuitable for lung transplantation, 38 (12%) refused lung transplantation, 65 (21%) were too early to be listed, and 48 (15%) died before their assessment (n = 34) or being listed (n = 14). Of the 100 patients listed for lung transplantation, 57 underwent bilateral lung transplantation, 22 underwent heart-lung transplantation, 18 died while waiting, and 3 were still waiting. The waiting list mortality was the greatest for patients with connective tissue disease-pulmonary arterial hypertension (34% vs 11% in the remaining patients, P=.005). The number of patients admitted to the hospital to be bridged to lung transplantation increased from 7% in the 1997-2004 cohort to 25% in the 2005-2010 cohort (P=.02). After lung transplantation, the 30-day mortality decreased from 24% in the 1997-2004 group to 6% in the 2005-2010 group (P=.007). The 10-year survival was worse for those with idiopathic pulmonary arterial hypertension (42% vs 70% for the remaining patients, P=.01). The long-term survival reached 69% at 10 years in the patients with connective tissue disease pulmonary arterial hypertension. Conclusions: Lung transplantation is an option for about one third of the patients with pulmonary arterial hypertension referred for lung transplantation. The 30-day mortality after lung transplantation improved significantly over time, but the long-term survival remained similar between the two cohorts. Patients with connective tissue disease-pulmonary arterial hypertension have a high mortality on the waiting list but excellent long-term survival. (J Thorac Cardiovasc Surg 2012; 143: 910-8)
引用
收藏
页码:910 / 918
页数:9
相关论文
共 19 条
[1]   Does reperfusion injury still cause significant mortality after lung transplantation? [J].
Ailawadi, Gorav ;
Lau, Christine L. ;
Smith, Philip W. ;
Swenson, Brian R. ;
Hennessy, Sara A. ;
Kuhn, Courtney J. ;
Fedoruk, Lynn M. ;
Kozower, Benjamin D. ;
Kron, Irving L. ;
Jones, David R. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2009, 137 (03) :688-694
[2]   Hemodynamic Predictors of Survival in Scleroderma-related Pulmonary Arterial Hypertension [J].
Campo, Aranzazu ;
Mathai, Stephen C. ;
Le Pavec, Jerome ;
Zaiman, Ari L. ;
Hummers, Laura K. ;
Boyce, Danielle ;
Housten, Traci ;
Champion, Hunter C. ;
Lechtzin, Noah ;
Wigley, Fredrick M. ;
Girgis, Reda E. ;
Hassoun, Paul M. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2010, 182 (02) :252-260
[3]   Impact of the Lung Allocation Score on Lung Transplantation for Pulmonary Arterial Hypertension [J].
Chen, Hubert ;
Shiboski, Stephen C. ;
Golden, Jeffrey A. ;
Gould, Michael K. ;
Hays, Steven R. ;
Hoopes, Charles W. ;
De Marco, Teresa .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2009, 180 (05) :468-474
[4]   The Registry of the International Society for Heart and Lung Transplantation: Twenty-seventh official adult lung and heart-lung transplant report-2010 [J].
Christie, Jason D. ;
Edwards, Leah B. ;
Kucheryavaya, Anna Y. ;
Aurora, Paul ;
Dobbels, Fabienne ;
Kirk, Richard ;
Rahmel, Axel O. ;
Stehlik, Josef ;
Hertz, Marshall I. .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2010, 29 (10) :1104-1118
[5]   Prevalence of gastroesophageal reflux in end-stage lung disease candidates for lung transplant [J].
D'Ovidio, F ;
Singer, LG ;
Hadjiliadis, D ;
Pierre, A ;
Waddell, TK ;
de Perrot, M ;
Hutcheon, M ;
Miller, L ;
Darling, G ;
de Perrot, M ;
Hutcheon, M ;
Miller, L ;
Darling, G ;
Keshavjee, S .
ANNALS OF THORACIC SURGERY, 2005, 80 (04) :1254-1261
[6]  
de Perrot M, CHEST
[7]   Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience [J].
de Perrot, Marc ;
Waddell, Thomas K. ;
Shargall, Yaron ;
Pierre, Andrew F. ;
Fadel, Elie ;
Uy, Karl ;
Chaparro, Cecilia ;
Hutcheon, Michael ;
Singer, Lianne G. ;
Keshavjee, Shaf .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2007, 133 (02) :525-531
[8]   Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation [J].
de Perrot, Marc ;
Granton, John T. ;
McRae, Karen ;
Cypel, Marcelo ;
Pierre, Andrew ;
Waddell, Thomas K. ;
Yasufuku, Kazuhiro ;
Hutcheon, Michael ;
Chaparro, Cecilia ;
Singer, Lianne ;
Keshavjee, Shaf .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2011, 30 (09) :997-1002
[9]   Pulmonary arterial hypertension in paediatric and adult patients with congenital heart disease [J].
Gatzoulis, M. A. ;
Alonso-Gonzalez, R. ;
Beghetti, M. .
EUROPEAN RESPIRATORY REVIEW, 2009, 18 (113) :154-161
[10]   Is Pulmonary Arterial Hypertension Really a Late Complication of Systemic Sclerosis? [J].
Hachulla, Eric ;
Launay, David ;
Mouthon, Luc ;
Sitbon, Olivier ;
Berezne, Alice ;
Guillevin, Loic ;
Hatron, Pierre-Yves ;
Simonneau, Gerald ;
Clerson, Pierre ;
Humbert, Marc .
CHEST, 2009, 136 (05) :1211-1219