Heart Failure and Transplantation Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Transplant Proc. 2022 Nov;54(9):2500-2502. doi: 10.1016/j.transproceed.2022.10.003. Epub 2022 Oct 29.
The outcomes of heart-lung transplant (HLT) are worse than those of heart transplant (HT) and lung transplant alone; this and the availability of mechanical assistance have meant that the indications for HLT have been changing. This study aims to analyze the evolution of indications for HLT in a country of 47 million inhabitants.
We performed a retrospective observational study of all HLTs performed in Spain (performed in 2 centers) from 1990 to 2020. The total number of patients included was 1751 (HT 1673 and HLT 78). After clinical adjustment, overall survival was compared between the 2 groups. Seven etiological subgroups were considered within the HLT group: (1) cardiomyopathy with pulmonary hypertension (CM + PH);, (2) Eisenmenger syndrome, (3) congenital heart disease without Eisenmenger syndrome, (4) idiopathic pulmonary arterial hypertension (IPAH), (5) cystic fibrosis, (6) chronic obstructive pulmonary disease (COPD) and/or emphysema), and (7) diffuse interstitial lung disease.
There were a large number of differences between patients with HLT vs HT. HLT had a 2.69-fold increased probability of death in the first year compared with HT. The indications for HLT have changed over the years. In the recent period the indications are mainly congenital heart disease and Eisenmenger syndrome, with some cases of CM + PH. Other indications for HLT have virtually disappeared, mainly lung diseases (IPAH, COPD, cystic fibrosis). Median survival was low in CM + PH (18 days), diffuse interstitial lung disease (29 days), and ischemic heart disease (114 days); intermediate in Eisenmenger syndrome (600 days); and longer in IPAH, COPD and/or emphysema, and cystic fibrosis.
HLT is a procedure with high mortality. This and mechanical assists mean that the indications have changed over the years. Etiological analysis is of utmost interest to take advantage of organs and improve survival.
心肺移植（HLT）的结果比单纯心脏移植（HT）和肺移植差；这一情况以及机械辅助的出现意味着 HLT 的适应证一直在变化。本研究旨在分析一个拥有 4700 万居民的国家中 HLT 适应证的演变。
我们对 1990 年至 2020 年在西班牙进行的所有 HLT 进行了回顾性观察研究（在 2 个中心进行）。共纳入 1751 例患者（HT 1673 例，HLT 78 例）。在进行临床调整后，比较了两组患者的总生存率。HLT 组内考虑了 7 个病因亚组：（1）合并肺动脉高压的心肌病（CM+PH）；（2）艾森曼格综合征；（3）无艾森曼格综合征的先天性心脏病；（4）特发性肺动脉高压（IPAH）；（5）囊性纤维化；（6）慢性阻塞性肺疾病（COPD）和/或肺气肿；（7）弥漫性间质性肺病。
与 HT 患者相比，HLT 患者有大量差异。HLT 患者在第 1 年死亡的可能性是 HT 患者的 2.69 倍。HLT 的适应证多年来发生了变化。在最近一段时间，主要的适应证是先天性心脏病和艾森曼格综合征，还有一些 CM+PH 病例。HLT 的其他适应证几乎消失，主要是肺部疾病（IPAH、COPD、囊性纤维化）。CM+PH（18 天）、弥漫性间质性肺病（29 天）和缺血性心脏病（114 天）患者的中位生存期较低；艾森曼格综合征（600 天）患者的中位生存期居中；IPAH、COPD 和/或肺气肿和囊性纤维化患者的中位生存期较长。
HLT 是一种死亡率较高的手术。这一情况和机械辅助意味着适应证多年来一直在变化。病因分析对于充分利用器官和提高生存率非常重要。
