Lung Transplantation For End-stage Pulmonary Diseases With Pulmonary Hypertention:A Single-center Experience

BackgroundLung transplantation is a treatment for end-stage lung disease.The optimal transplant strategy for patients with end-stage lung disease complicated by pulmonary hypertension is controversial.The aim of this study is to review this experience and analyze the outcomes of lung transplantation for pulmonary hypertension.MethodsThis retrospective study collected data on patients with pulmonary hypertension undergoing lung transplantation between March 2016 and December 2019 at a single center in China.The perioperative features and short-and medium-term outcomes between single-lung transplantation(SLT)and double-lung transplantation(DLT)were compared.Kaplan-Meier methods were used to analyze overall survival across a variety of transplantation procedures,age,mean pulmonary pressure(m PAP),body mass index(BMI),and indication of transplantation.ResultsA total of 213 patients underwent lung transplantation during this period,of whom 63 patients with pulmonary hypertension were included in the analysis.The mean age,mean BMI,and m PAP was 56.37 years,19.56 kg/m2,and 35.4 mm Hg respectively.The overall 1-,2-,and 3-year survival was 70%,63%,and 60%,respectively.Five(7.94%)patients died within 30 days after surgery and nine patients(14.3%)died from infection during the followed-up period.Survival rate at1,2,and 3 years were 73%,69%,65%in SLT,and 65%,43%,43%in DLT.There were no significant differences on the short-and medium-term survival outcomes of SLT and DLT(P=0.23).Both SLT and DLT could improve pulmonary hypertension and lung function.There was no significant difference in the improvement of pulmonary hypertension between SLT and DLT(P=0.23),and DLT offered better forced expiratory volume in the first second(FEV1)(P=0.02)and FEV1/forced vital capacity(FVC)(P<0.01).Patients older than 60 years of age had worse survival(P=0.01).The survival for m PAP<40 vs.≥40 mm Hg(P=0.66),BMI<17 kg/m~2 vs.17≤BMI<25 kg/m~2(P=0.52),and chronic obstructive pulmonary disease vs.interstitial lung disease(P=0.64)were similar.ConclusionsThe short-and medium-term survival outcomes between SLT and DLT are similar in selected patients with pulmonary hypertention.DLT provides better pulmonary function.Patients older than 60 years are associated with worse survival.