Feldman Jeremy P, Gomberg-Maitland Mardi, Shapiro Shelley M, Lautenbach Amy A, Morris Marty, Murphy Jeff A, Waxman Aaron B, Bourge Robert C
Arizona Pulmonary Specialists, Ltd, Phoenix, AZ, USA.
George Washington University Medicine and Health Sciences, Washington DC, USA.
Pulm Circ. 2021 Mar 2;11(1):2045894021999290. doi: 10.1177/2045894021999290. eCollection 2021 Jan-Mar.
The implanted system for treprostinil has been described in previous publications. There is no information published about how to handle this system around lung or heart-lung transplantation. We present the experience from the DelIVery for Pulmonary Arterial Hypertension study. Seven subjects from five pulmonary arterial hypertension centers were included in this retrospective chart review. All subjects were participating in the previously described DelIVery for pulmonary arterial hypertension study. Seven subjects with implanted pumps have been listed for lung or heart-lung transplant. Six subjects underwent lung or heart-lung transplantation and one remains on the transplant list. Three different methods of patient management for transplant were used. In three subjects, the implanted system was filled with saline prior to transplantation and treprostinil was infused via an external system. Three subjects had their drug-filled implanted pump and catheter system explanted at the time of transplant. One patient had the drug-filled implanted system removed prior to being listed for transplantation. Four subjects were hospitalized while waiting for transplantation. In conclusion, the implanted system for treprostinil is an important advance in the care of pulmonary arterial hypertension subjects. The experience described here provides three effective strategies for managing the implanted system around lung or heart-lung transplantation. The optimal strategy will depend on patient characteristics and lung transplant program preferences and wait list times.
前列环素植入系统已在先前的出版物中有所描述。目前尚无关于在肺移植或心肺移植前后如何处理该系统的相关信息发表。我们介绍了肺动脉高压药物递送研究（DelIVery for Pulmonary Arterial Hypertension study）的经验。本回顾性病历审查纳入了来自五个肺动脉高压中心的七名受试者。所有受试者均参与了先前描述的肺动脉高压药物递送研究。七名植入了泵的受试者已被列入肺移植或心肺移植名单。六名受试者接受了肺移植或心肺移植，一名仍在移植名单上。采用了三种不同的移植患者管理方法。三名受试者在移植前将植入系统充满生理盐水，然后通过外部系统输注前列环素。三名受试者在移植时取出了装有药物的植入泵和导管系统。一名患者在被列入移植名单之前取出了装有药物的植入系统。四名受试者在等待移植期间住院。总之，前列环素植入系统是肺动脉高压患者护理方面的一项重要进展。此处描述的经验为在肺移植或心肺移植前后管理植入系统提供了三种有效策略。最佳策略将取决于患者特征、肺移植项目偏好以及等待名单时间。
