  
Pulmonary hypertension not linked with poorer long-term outcome after lung transplant
Last Updated: 2001-01-29 13:38:18 EST (Reuters Health)
NEW ORLEANS (Reuters Health) - Despite a higher early mortality rate, lung transplantation for pulmonary hypertension (PHT) achieves long-term results that are similar to outcomes for other indications, according to the findings of a study presented January 29 at the 37th annual meeting of The Society of Thoracic Surgeons.
Dr. Bryan F. Meyers, from Washington University School of Medicine, in St. Louis, and colleagues performed a 10-year retrospective analysis of data from 55 adult and 45 pediatric PHT patients who underwent single lung, bilateral lung, or heart-lung transplantation. Forty-eight percent of patients had primary PHT and 52% had secondary PHT. The average New York Heart Association (NYHA) class was 3.2 and the mean pulmonary artery pressure was 64 mm Hg.
Thirty-day hospital mortality, usually due to graft failure and infection, was 11%, the investigators note. At a mean follow-up of 4 years, the 1- and 5-year actuarial survival was 75% and 57%, respectively. Survival was not significantly influenced by diagnosis or type of transplant.
Average pulmonary artery pressure and New York Heart Association class were significantly lower after transplantation than before, the researchers emphasize.
"The value of this study, as a physician who looks at patients as possible lung transplant candidates, is that it allows me to assess their likelihood of survival and functional benefit and contrast that with what the currently available medical therapies can achieve," Dr. Meyers told Reuters Health.
"If you look back at the number of transplantations that were done for pulmonary hypertension in adults over the past 10 years, you see a cautious experimentation with it back in the late 80s and early 90s," Dr. Meyers said. "The heyday of lung transplantation for pulmonary hypertension was in the mid-90s, but after the development of continuous prostaglandin infusion, there was a near disappearance of transplantation referrals for this indication," he pointed out.
"Lung transplantation for adults is kind of the great equalizer," Dr. Meyers noted. "You can take a lot of diseases that have varying degrees of disability and likelihood of death and basically patients, once they've had a transplant, all tend to cluster together with the same degrees of disability and the same long-term risks of death," he explained.
The finding of similar long-term results after transplantation for different diseases suggests that "the reason for people failing in the long run after lung transplantation is either due to chronic rejection or due to infections that have been made possible due to enhanced immunosuppression," Dr. Meyers stated.
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