Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: A 14-year single-center experience
Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: A 14-year single-center experience
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DOI：
10.1016/j.jtcvs.2011.08.055
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发表时间：
2012-04-01
影响因子：
6
通讯作者：
Keshavjee, Shaf
中科院分区：
文献类型：
--
作者：
de Perrot, Marc;Granton, John T.;Keshavjee, Shaf
目的：分析肺动脉高压患者转介肺移植的转归，并确定其随时间的变化。方法：回顾1997年1月至2010年9月在本项目中转诊的所有肺动脉高压患者。肺动脉高压被归类为特发性（123例）或与先天性心脏病（77例）、结缔组织疾病（102例）或慢性血栓栓塞性疾病（14例）相关。结果：完成评估后，发现61例（19%）患者不适合肺移植，38例（12%）患者拒绝肺移植，65例（21%）患者过早列入名单，48例（15%）患者在评估前（n = 34）或未列入名单（n = 14）。100例肺移植患者中，57例行双侧肺移植，22例行心肺移植，18例在等待中死亡，3例仍在等待中。结缔组织疾病-肺动脉高压患者的等候名单死亡率最高（34% vs 11%， P= 0.005）。入院接受肺移植的患者数量从1997-2004年队列的7%增加到2005-2010年队列的25% （P= 0.02）。肺移植后，30天死亡率从1997-2004年组的24%下降到2005-2010年组的6% （P=.007）。特发性肺动脉高压患者的10年生存率较差（42% vs 70%， P= 0.01）。结缔组织病肺动脉高压患者10年长期生存率达69%。结论：约三分之一的肺动脉高压患者转诊行肺移植可选择肺移植。随着时间的推移，肺移植后的30天死亡率显著提高，但两组患者的长期生存率保持相似。结缔组织疾病-肺动脉高压患者在等待名单上死亡率很高，但长期生存率很好。（中华胸心外科杂志；2012;43:910-8）
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)