Transplantation for Idiopathic Pulmonary Arterial Hypertension: Improvement in the Lung Allocation Score Era
Background—Lung transplant (LUT) and heart-lung transplant (HLT) represent surgical options for treating medically refractory idiopathic pulmonary arterial hypertension (IPAH). The effect of the lung allocation score (LAS) on waitlist and transplant outcomes in IPAH patients is poorly described.
Methods and Results—Adults diagnosed with IPAH and listed for transplant in the 80 months before and after the LAS 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-LAS era. The cumulative incidences of transplant and mortality for waitlisted patients in both eras were appraised with competing outcomes analysis. Post-transplant survival was assessed with the Kaplan-Meier method. These analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of pre-listing and pre-transplant characteristics on mortality. We found that post-LAS-era patients had significantly worse comorbidities; nevertheless, both LUT and HLT candidates in this era enjoyed lower waitlist mortality and a higher incidence of transplant in our unmatched and propensity-matched analyses. On multivariable analysis, HLT and double-lung transplant (DLT) were associated with improved survival from the time of waitlisting, as was being listed at a medium-to-high-volume institution. Donor/recipient gender matching predicted post-transplant survival.
Conclusions—The incidence of transplant has increased while waitlist mortality has decreased in IPAH patients waitlisted for transplant in the post-LAS era. Both HLT and DLT are predictive of survival in transplant candidates with IPAH, as is being listed at a medium-to-high-volume institution. Donor/recipient gender-matching is associated with better post-transplant survival.
- Received January 2, 2013.
- Revision received April 9, 2013.
- Accepted April 24, 2013.