Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Chronic Diseases, Metabolism, and Ageing, Catholic University Leuven, Leuven, Belgium.
Transpl Int. 2019 Jul;32(7):717-729. doi: 10.1111/tri.13409. Epub 2019 Mar 5.
Transplant type for end-stage pulmonary vascular disease remains debatable. We compared recipient outcome after heart-lung (HLT) versus double-lung (DLT) transplantation. Single-center analysis (38 HLT-30 DLT; 1991-2014) for different causes of precapillary pulmonary hypertension (PH): idiopathic (22); heritable (two); drug-induced (nine); hepato-portal (one); connective tissue disease (four); congenital heart disease (CHD) (24); chronic thromboembolic PH (six). HLT decreased from 91.7% [1991-1995] to 21.4% [2010-2014]. Re-intervention for bleeding was higher after HLT; (P = 0.06) while primary graft dysfunction grades 2 and 3 occurred more after DLT; (P < 0.0001). Graft survival at 90 days, 1, 5, 10, and 15 years was 93%, 83%, 70%, 47%, and 35% for DLT vs. 82%, 74%, 61%, 48%, and 30% for HLT, respectively (log-rank P = 0.89). Graft survival improved over time: 100%, 93%, 87%, 72%, and 72% in [2010-2014] vs. 75%, 58%, 42%, 33%, and 33% in [1991-1995], respectively; P = 0.03. No difference in chronic lung allograft dysfunction (CLAD)-free survival was observed: 80% & 28% for DLT vs. 75% & 28% for HLT after 5 and 10 years, respectively; P = 0.49. Primary graft dysfunction in PH patients was lower after HLT compared to DLT. Nonetheless, overall graft and CLAD-free survival were comparable and improved over time with growing experience. DLT remains our preferred procedure for all forms of precapillary PH, except in patients with complex CHD.
用于终末期肺血管疾病的移植类型仍存在争议。我们比较了心肺联合移植（HLT）与双肺移植（DLT）后受体的结局。为不同原因的毛细血管前肺动脉高压（PH）进行的单中心分析（38 例 HLT-30 例 DLT；1991-2014 年）：特发性（22 例）；遗传性（2 例）；药物性（9 例）；肝门静脉（1 例）；结缔组织疾病（4 例）；先天性心脏病（CHD）（24 例）；慢性血栓栓塞性 PH（6 例）。HLT 从 91.7%（1991-1995 年）降至 21.4%（2010-2014 年）。HLT 后出血再干预更高（P=0.06），而 DLT 后出现更高级别的原发性移植物功能障碍 2 级和 3 级（P<0.0001）。90 天、1 年、5 年、10 年和 15 年的移植物存活率分别为 DLT 组 93%、83%、70%、47%和 35%，HLT 组为 82%、74%、61%、48%和 30%，（对数秩检验 P=0.89）。移植物存活率随时间改善：2010-2014 年为 100%、93%、87%、72%和 72%，而 1991-1995 年分别为 75%、58%、42%、33%和 33%；P=0.03。慢性肺同种异体移植物功能障碍（CLAD）无差异：5 年和 10 年时 DLT 组为 80%和 28%，HLT 组为 75%和 28%，P=0.49。PH 患者的原发性移植物功能障碍在 HLT 后低于 DLT。尽管如此，随着经验的积累，整体移植物和 CLAD 无生存获益仍相当，并随时间改善。除了复杂 CHD 患者外，DLT 仍然是我们治疗所有形式毛细血管前 PH 的首选方法。
