Single lung transplantation in patients with severe secondary pulmonary hypertension

Nasir, Basil S.; Mulvihill, Michael S.; Barac, Yaron D.; Bishawi, Muath; Cox, Morgan L.; Megna, D.; Haney, John C.; Klapper, Jacob A.; Daneshmand, Mani A.; Hartwig, Matthew G.

doi:10.1016/j.healun.2019.06.014

Cited by 20 publications

(14 citation statements)

References 19 publications

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“…As double Ltx provides superior survival in comparison to its single lung counterpart (50% survival over 7.8 years for double lung transplant [DLT] vs. 4.8 years for SLT, p < 0.0001), it is generally advised to perform bilateral Ltx [ 57 ]. Additionally, there is an increased mortality hazard among SLT recipients with an mPAP exceeding 40 mmHg, as reported by Nasir et al [ 66 ]. Median survival of Ltx recipients due to PAH was 12 years among those who reached at least 1-year survival after transplantation [ 57 ].…”

Section: Thoracic Organ Transplantationmentioning

confidence: 70%

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Stącel

Latos

Urlik

et al. 2021

JCM

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Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

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Section: Thoracic Organ Transplantationmentioning

confidence: 70%

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Stącel

Latos

Urlik

et al. 2021

JCM

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“…Fitton et al also found survival to be equivalent with mild/moderate PHTN (vs. severe PHTN) in both SLT and BLT, concluding that SLT is an acceptable transplantation option (21). Finally, a recent 2019 study which looked at PHTN stratified by mPAP (<40 vs. ≥40 mmHg) also found those who underwent SLT with mPAP <40 mmHg to have a higher long-term survival compared to those with mPAP ≥40 mmHg, further offering evidence that SLT in mild/moderate PHTN is acceptable (22).…”

Section: Discussionmentioning

confidence: 97%

Transpulmonary gradient as a predictor for outcomes after lung transplantation

Chan¹,

Madde²,

Furukawa³

et al. 2022

Shanghai Chest

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Background: End stage lung disease (ESLD) is commonly associated with pulmonary hypertension (PHTN). In a donor restrictive environment, offering patients single over double lung transplants could increase organ utilization. However, there isn't a clinical consensus on how severe PHTN must be to preclude single lung transplant (SLT) due to poor outcomes. We sought to investigate the predictive value of the transpulmonary gradient (TPG) in SLT in patients with ESLD and PHTN. Methods: We performed a retrospective analysis of the United Network for Organ Sharing database and identified all patients who underwent lung transplantation (LT) from May 2005 to March 2021. Patients were stratified based on their TPG score above or below 25 mmHg. Primary outcomes include 1-year survival assessed by generalized linear mixed modeling.Results: Our analysis showed TPG was associated with 1-year survival but this relationship depended on transplant type (P=0.002) with TPG ≥25 being associated with higher mortality in single (P=0.004), but not double LT (P=0.95). This association was maintained when covarying for numerous clinical factors, as well as when excluding deaths within 90 days of LT (P=0.04).Conclusions: A preoperative TPG >25 was associated with decreased 1-year survival in SLT recipients.The use of preoperative TPG combined with other marks of clinical status can help transplant centers in their decision of offering single vs. double lung transplant in patients with ESLD and PHTN.

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“…In unilateral LTx, however, PAP mean !40 mm Hg represented an independent predictor of death. 68 No differences were seen in unilateral LTx with raised PAP mean <40 mm Hg and those without PH. It should be reiterated, however, that this analysis collated restrictive and obstructive lung disease and that the former accounted for 78% of the severe PH group.…”

Section: Bilateral Versus Unilateral Ltx In Copdmentioning

confidence: 90%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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Single lung transplantation in patients with severe secondary pulmonary hypertension

Cited by 20 publications

References 19 publications

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Transpulmonary gradient as a predictor for outcomes after lung transplantation

Chronic Obstructive Pulmonary Disease and Lung Transplantation

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