Abstract 10479: Improved Survival with Lung and Heart-Lung Transplantation in Idiopathic Pulmonary Hypertension Patients: Analysis of the United Network for Organ Sharing Database
OBJECTIVE: Lung (LU) and heart-lung (HL) transplant are options for idiopathic pulmonary hypertension (IPH) refractory to medical management. Outcomes for these patients are poorly described.
METHOD: Adult patients diagnosed with IPH listed for LU or HL transplant were identified from the United Network for Organ Sharing database (1/2000-9/2009). Patients were stratified by organ type and whether they underwent transplant or remained on the waiting list. Survival from time of listing was assessed with Kaplan Meier analysis. Cox proportional hazards regression was used to determine predictors of late survival.
RESULTS: Of 904 patients placed on the waitlist, 261 were transplanted (56 HL, 205 LU) and 643 never underwent transplant (74 HL, 569 LU). The characteristics of the 4 groups are shown in Table 1. Figure 1 shows the Kaplan Meier survival curve illustrating significant differential survival between the 4 cohorts across 5 years. Cox proportional hazards modeling identified hospitalization (hazards ratio [HR] 2.8, 95% confidence interval [CI] 1.5-5.2, p=0.01), lung allocation score (HR 1.06, 95% CI 1.05-1.08, p<0.001) and undergoing transplantation (HR 0.5, 95% CI 0.3-0.9, p=0.02) as significant independent predictors of mortality.
CONCLUSION: Patients transplanted for IPH had better survival than patients not transplanted. In the modern era HL patients have similar survival to LU patients when transplanted, despite their higher baseline risk. This increased baseline risk is reflected in higher waitlist mortality among HL patients. These findings suggest that earlier listing of patients with IPH for transplant, especially in candidates for HL, may improve outcomes.
- © 2011 by American Heart Association, Inc.