Transplantation for idiopathic pulmonary arterial hypertension: Improvement in the lung allocation score era

Justin M. Schaffer, Steve K. Singh, David L. Joyce, Bruce A. Reitz, Robert C. Robbins, Roham T. Zamanian, Hari R. Mallidi

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

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 transplantation were associated with improved survival from the time of wait-listing, as was being listed at a medium-to high-volume institution. Donor/recipient sex matching predicted posttransplantation survival. Conclusions-The incidence of transplantation has increased while wait-list mortality has decreased in patients with idiopathic pulmonary arterial hypertension wait-listed for transplantation in the post-lung allocation score era. Both heart-lung transplantation and double-lung transplantation are predictive of survival in transplantation candidates with idiopathic pulmonary arterial hypertension, as is being listed at a medium-to high-volume institution. Donor/recipient sex matching is associated with better posttransplantation survival.

Original languageEnglish (US)
Pages (from-to)2503-2513
Number of pages11
JournalCirculation
Volume127
Issue number25
DOIs
StatePublished - Jun 25 2013

Keywords

  • hypertension
  • hypertension, pulmonary
  • statistics
  • survival
  • transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Schaffer, J. M., Singh, S. K., Joyce, D. L., Reitz, B. A., Robbins, R. C., Zamanian, R. T., & Mallidi, H. R. (2013). Transplantation for idiopathic pulmonary arterial hypertension: Improvement in the lung allocation score era. Circulation, 127(25), 2503-2513. https://doi.org/10.1161/CIRCULATIONAHA.112.001080