Prognosis of lung transplantation in the treatment of end-stage pulmonary arterial hypertension_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Hongmei , WU Bo , FAN Li , ZHOU Min , YANG Hang , WEI Dong , ZHANG Caixin , XIONG Dian , YUE Bingqing , ZHOU Haiqin ,  CHEN Jingyu

Department of Pulmonary and Critical Care Medicine, Lung Transplantation Center, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P. R. China;

Corresponding author：

CHEN Jingyu, Email: chenjy@wuxiph.com

Keywords：

Lung transplantation; End-stage pulmonary arterial hypertension; Prognosis; Quality of life

DOI：

10.7507/1671-6205.202208067

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Objective To assess the effects of lung transplantation (LT) in the treatment of end-stage pulmonary arterial hypertension (PAH) and evaluated its impact on quality of life (QoL). Methods A total of 54 patients with end-stage PAH admitted to the LT center of Wuxi People’s Hospital between January 2007 and June 2019 were retrospectively analyzed. The patients were divided into surgical and non-surgical groups. Clinical data were compared between the groups. The clinical data such as symptoms, signs, biochemistry, survival rate and quality of life were compared between the two groups. The effects of lung transplantation on survival and quality of life were analyzed. The quality of life was scored by SF-36 scale. Results A total of 54 patients with end-stage pulmonary arterial hypertension who met the indications for lung transplantation were enrolled. Among them, 36 patients underwent lung transplantation and 18 patients did not undergo surgery. There were no statistical differences in gender, course of disease, disease type, symptoms between the two groups. The uric acid of the non-operation group was significantly higher than that of the lung transplantation group (P=0.014). The systolic pulmonary artery pressure (SPAP) of the non-operation group was significantly lower than that of the lung transplantation group (P=0.046). Kaplan-Meier survival curve showed that the survival rate of the operation group was higher than that of the non-operation group (P=0.0087). The quality of life assessment showed that after lung transplantation, the physical component summary and mental component summary scores of operation group were higher than those before operation (P<0.01), and also higher than non-operation group in the same period (P<0.05). Preoperative low systemic circulation blood pressure, poor cardiac function, high NT-proBNP and high uric acid may be the risk factors for early death of patients with pulmonary arterial hypertension after lung transplantation. Conclusions Lung transplantation can effectively improve survival and also QoL for patients with end-stage PH. Early detection of risk factors and preoperative assessment can help improve the perioperative survival.

Citation： WANG Hongmei, WU Bo, FAN Li, ZHOU Min, YANG Hang, WEI Dong, ZHANG Caixin, XIONG Dian, YUE Bingqing, ZHOU Haiqin, CHEN Jingyu. Prognosis of lung transplantation in the treatment of end-stage pulmonary arterial hypertension. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(8): 572-576. doi: 10.7507/1671-6205.202208067 Copy

1.	D’Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med, 1991, 115(5): 343-349.
2.	王利婷, 荆志成. 肺动脉高压治疗药物研究进展. 国际药学研究杂志, 2017, 44(2): 127-134.
3.	Corris PA. Alternatives to lung transplantation: treatment of pulmonary arterial hypertension. Clin Chest Med, 2011, 32(2): 399-410.
4.	McLaughlin VV, Archer Sl, Badesch DB, et al. ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc. , and the Pulmonary Hypertension Association. Circulation, 2009, 119(16): 2250-2294.
5.	Stringham R, Shah NR. Pulmonary arterial hypertension: an update on diagnosis and treatment. Am Fam Physician, 2010, 82(4): 370-377.
6.	Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society(ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
7.	Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J, 2009, 30(20): 2493-2537.
8.	Orens JB, Estenne M, Arcasoy S, et al. International Guidelines for the Selection of Lung Transplant Candidates: 2006 update-A Consensus Report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2006, 25(7): 745-755.
9.	Weill D, Benden C, Corris PA, et al. A Consensus Document for the Selection of Lung Transplant Candidates: 2014–An Update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2015, 34(1): 1-15.
10.	Hill C, Maxwell B, Boulate D, et al. Heart-lung vs. double-lung transplantation for idiopathic pulmonary arterial hypertension. Clin Transplant, 2015, 29(12): 1067-1075.
11.	Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart-Lung Transplant Report – 2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
12.	De Perrot M, Granton JT, Mcrae K, et al. Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: a 14-year single-center experience. J Thorac Cardiovasc Surg, 2012, 143(4): 910-918.
13.	Thabut G, Christie JD, Kremers WK, et al. Survival differences following lung transplantation among US transplant centers. JAMA, 2010, 304(1): 53-60.
14.	Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation, 2010, 122(2): 164-172.
15.	Brouckaert J, Verleden SE, Verbelen T, et al. Double-lung versus heart-lung transplantation for precapillary pulmonary arterial hypertension: a 24-year single-center retrospective study. Transpl Int, 2019, 32(7): 717-729.
16.	Olland A, Falcoz PE, Canuet M, et al. Should we perform bilateral-lung or heart–lung transplantation for patients with pulmonary hypertension?. Interact Cardiovasc Thorac Surg, 2013, 17(1): 166-170.
17.	Kim CY, Park JE, Leem AY, et al. Prognostic value of pre-transplant mean pulmonary arterial pressure in lung transplant recipients: a single-institution experience. J Thorac Dis, 2018, 10(3): 1578-1587.

1. D’Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med, 1991, 115(5): 343-349.
2. 王利婷, 荆志成. 肺动脉高压治疗药物研究进展. 国际药学研究杂志, 2017, 44(2): 127-134.
3. Corris PA. Alternatives to lung transplantation: treatment of pulmonary arterial hypertension. Clin Chest Med, 2011, 32(2): 399-410.
4. McLaughlin VV, Archer Sl, Badesch DB, et al. ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc. , and the Pulmonary Hypertension Association. Circulation, 2009, 119(16): 2250-2294.
5. Stringham R, Shah NR. Pulmonary arterial hypertension: an update on diagnosis and treatment. Am Fam Physician, 2010, 82(4): 370-377.
6. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society(ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
7. Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J, 2009, 30(20): 2493-2537.
8. Orens JB, Estenne M, Arcasoy S, et al. International Guidelines for the Selection of Lung Transplant Candidates: 2006 update-A Consensus Report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2006, 25(7): 745-755.
9. Weill D, Benden C, Corris PA, et al. A Consensus Document for the Selection of Lung Transplant Candidates: 2014–An Update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2015, 34(1): 1-15.
10. Hill C, Maxwell B, Boulate D, et al. Heart-lung vs. double-lung transplantation for idiopathic pulmonary arterial hypertension. Clin Transplant, 2015, 29(12): 1067-1075.
11. Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart-Lung Transplant Report – 2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
12. De Perrot M, Granton JT, Mcrae K, et al. Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: a 14-year single-center experience. J Thorac Cardiovasc Surg, 2012, 143(4): 910-918.
13. Thabut G, Christie JD, Kremers WK, et al. Survival differences following lung transplantation among US transplant centers. JAMA, 2010, 304(1): 53-60.
14. Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation, 2010, 122(2): 164-172.
15. Brouckaert J, Verleden SE, Verbelen T, et al. Double-lung versus heart-lung transplantation for precapillary pulmonary arterial hypertension: a 24-year single-center retrospective study. Transpl Int, 2019, 32(7): 717-729.
16. Olland A, Falcoz PE, Canuet M, et al. Should we perform bilateral-lung or heart–lung transplantation for patients with pulmonary hypertension?. Interact Cardiovasc Thorac Surg, 2013, 17(1): 166-170.
17. Kim CY, Park JE, Leem AY, et al. Prognostic value of pre-transplant mean pulmonary arterial pressure in lung transplant recipients: a single-institution experience. J Thorac Dis, 2018, 10(3): 1578-1587.

Chinese Journal of Respiratory and Critical Care Medicine

Prognosis of lung transplantation in the treatment of end-stage pulmonary arterial hypertension

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