Transplantation for Idiopathic Pulmonary Arterial Hypertension

作者：Justin M. Schaffer, Steve K. Singh, David L. Joyce, Bruce A. Reitz, Robert C. Robbins, Roham T. Zamanian, Hari Reddy Mallidi · 发表于：Circulation · 年份：2013 · DOI：10.1161/circulationaha.112.001080 · 被引用次数：70 · 研究领域：Transplantation: Methods and Outcomes、Pulmonary Hypertension Research and Treatments、Mechanical Circulatory Support Devices

BACKGROUND: Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poorly described. METHODS AND RESULTS: Adults diagnosed with idiopathic pulmonary arterial hypertension and listed for transplantation in the 80 months before and after the lung allocation score algorithm was implemented (n=1430) were identified in the United Network for Organ Sharing thoracic registry. Patients were stratified by organ listed and pre- and post-lung allocation score era. The cumulative incidences of transplantation and mortality for wait-listed patients in both eras were appraised with competing outcomes analysis. Posttransplantation survival was assessed with the Kaplan-Meier method. These analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of prelisting and pretransplantation characteristics on mortality. We found that patients in the post-lung allocation score era had significantly worse comorbidities; nevertheless, both lung transplantation and heart-lung transplantation candidates in this era enjoyed lower wait-list mortality and a higher incidence of transplantation in unmatched and propensity-matched analyses. On multivariable analysis, heart-lung transplantation and double-lung tra...