Departments of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
Circulation. 2013 Jun 25;127(25):2503-13. doi: 10.1161/CIRCULATIONAHA.112.001080. Epub 2013 May 22.
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.
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.
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.
肺移植和心肺联合移植是治疗药物难治性特发性肺动脉高压的手术选择。肺分配评分对特发性肺动脉高压患者的等待名单和移植结果的影响描述得很差。
在美国器官共享联合网络胸部分部登记处，确定了在肺分配评分算法实施前后的 80 个月内被诊断为特发性肺动脉高压并被列入移植名单的成年人（n=1430）。根据器官列入名单和肺分配评分实施前后的时期对患者进行分层。使用竞争结果分析评估两个时期等待名单患者的移植和死亡率的累积发生率。使用 Kaplan-Meier 方法评估移植后的生存情况。在倾向匹配亚组中重复这些分析。Cox 比例风险分析评估了预列入名单和移植前特征对死亡率的影响。我们发现，肺分配评分后时期的患者合并症明显更差；尽管如此，在未匹配和倾向匹配分析中，该时期的肺移植和心肺联合移植候选者的等待名单死亡率较低，移植发生率较高。多变量分析显示，心肺联合移植和双肺移植与从等待名单开始的生存改善相关，在中等至大容量机构列入名单也是如此。供体/受体性别匹配预测移植后的生存。
在肺分配评分后时期，特发性肺动脉高压患者的移植发生率增加，而等待名单死亡率下降。心肺联合移植和双肺移植都是特发性肺动脉高压移植候选者的生存预测因素，在中等至大容量机构列入名单也是如此。供体/受体性别匹配与移植后生存更好相关。
