Pradère Pauline, Le Pavec Jérome, Bos Saskia, Pozza Andre, Nair Arun, Meachery Gerard, Lordan James, Humbert Marc, Mercier Olaf, Fadel Elie, Savale Laurent, Fisher Andrew J
Pneumology Department, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, Le Plessis Robinson, France.
Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK.
ERJ Open Res. 2024 Jan 22;10(1). doi: 10.1183/23120541.00521-2023. eCollection 2024 Jan.
Lung or heart-lung transplantation (LT/HLT) for severe pulmonary hypertension (PH) as the primary disease indication carries a high risk of waiting list mortality and post-transplant complications. France and the UK both have coordinated PH patient services but with different referral pathways for accessing LT services.
We conducted a comparative analysis of adult PH patients listed for LT/HLT in the UK and France.
We included 211 PH patients in France (2006-2018) and 170 in the UK (2010-2019). Cumulative incidence of transplant, delisting and waiting list death within 3 years were 81%, 4% and 11% in France 58%, 10% and 15% in the UK (p<0.001 for transplant and delisting; p=0.1 for death). Median non-priority waiting time was 45 days in France 165 days in the UK (p<0.001). High-priority listing occurred in 54% and 51% of transplanted patients respectively in France and the UK (p=0.8). Factors associated with achieving transplantation related to recipients' height, male sex, clinical severity and priority listing status. 1-year post-transplant survival was 78% in France and 72% in the UK (p= 0.04).
Access to transplantation for PH patients is better in France than in the UK where more patients were delisted due to clinical deterioration because of longer waiting time. High rates of priority listing occurred in both countries. Survival for those achieving transplantation was slightly better in France. Ensuring optimal outcomes after transplant listing for PH patients is challenging and may involve early listing of higher risk patients, increasing donor lung utilisation and improving allocation rules for these specific patients.
以重度肺动脉高压（PH）作为主要疾病指征进行肺移植或心肺联合移植（LT/HLT），在等待移植名单期间死亡及移植后并发症的风险很高。法国和英国都对PH患者服务进行了协调，但在获取LT服务的转诊途径方面有所不同。
我们对在英国和法国等待LT/HLT的成年PH患者进行了比较分析。
我们纳入了法国的211例PH患者（2006 - 2018年）和英国的170例患者（2010 - 2019年）。3年内移植、退出名单和等待名单死亡的累积发生率在法国分别为81%、4%和11%，在英国分别为58%、10%和15%（移植和退出名单方面p<0.001；死亡方面p = 0.1）。法国非优先等待时间中位数为45天，英国为165天（p<0.001）。法国和英国分别有54%和51%的移植患者被列为高优先级（p = 0.8）。与实现移植相关的因素包括受者身高、男性性别、临床严重程度和优先级列表状态。移植后1年生存率在法国为78%，在英国为72%（p = 0.04）。
法国PH患者的移植可及性优于英国，在英国更多患者因等待时间长导致临床病情恶化而退出名单。两国高优先级列表的比例都很高。在法国，实现移植的患者生存率略高。确保PH患者移植名单后的最佳结果具有挑战性，可能需要对高风险患者尽早列入名单、提高供肺利用率以及改进针对这些特定患者的分配规则。
