Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Transplant Proc. 2024 Oct;56(8):1803-1810. doi: 10.1016/j.transproceed.2024.08.025. Epub 2024 Sep 5.
In lung transplant, the United Network for Organ Sharing (UNOS) contains a diagnosis of secondary pulmonary hypertension (SPH). SPH and pulmonary arterial hypertension are treated the same in the allocation scoring system. It is not clear whether utilizing the SPH diagnosis instead of the primary diagnosis is helpful to patients or providers.
Analysis of UNOS data from May 2005 through July 2021, comparing patients listed under the SPH diagnosis with patients listed under COPD and interstitial lung disease (ILD) who met criteria for PH (COPD-PH and ILD-PH, respectively), as well as patients listed under pulmonary arterial hypertension (primary pulmonary hypertension, PPH). Competing-risk analysis examined waitlist and post-transplant outcomes. An exploratory analysis of UNOS spirometry data was performed.
Compared to patients listed under the SPH diagnosis, patients with ILD-PH were more likely to undergo transplantation (adjusted HR: 1.34, 95% confidence interval: 1.16-1.54, P < .001), with no significant difference comparing the SPH diagnosis to PPH or to COPD-PH. Waitlist mortality did not vary between groups. Post-transplant survival was lower in patients with PPH (adjusted HR: 1.35, 95% confidence interval: 1.04-1.75, P = .025), with no significant difference comparing the SPH diagnosis to COPD-PH or ILD-PH. Spirometry failed to demonstrate a clear phenotype within the SPH diagnosis.
In an adjusted analysis, patients with advanced lung disease and secondary PH were more likely to undergo transplantation when listed for ILD than when listed under the SPH diagnosis. The SPH diagnosis is too clinically heterogeneous to be useful in predictive models and should be considered for removal from UNOS.
在肺移植中，器官共享联合网络（UNOS）包含继发性肺动脉高压（SPH）的诊断。SPH 和肺动脉高压在分配评分系统中得到相同的治疗。目前尚不清楚使用 SPH 诊断而不是原发性诊断是否对患者或提供者有帮助。
分析 2005 年 5 月至 2021 年 7 月期间 UNOS 的数据，比较根据 SPH 诊断列出的患者与符合肺动脉高压标准的 COPD 和间质性肺疾病（分别为 COPD-PH 和 ILD-PH）列出的患者，以及根据原发性肺动脉高压（原发性肺动脉高压，PPH）列出的患者。竞争风险分析检查了等待名单和移植后的结果。对 UNOS 肺功能数据进行了探索性分析。
与根据 SPH 诊断列出的患者相比，ILD-PH 患者更有可能接受移植（调整后的 HR：1.34，95%置信区间：1.16-1.54，P<.001），而 SPH 诊断与 PPH 或 COPD-PH 之间没有显著差异。各组间等待名单死亡率无差异。PPH 患者的移植后生存率较低（调整后的 HR：1.35，95%置信区间：1.04-1.75，P=0.025），而 SPH 诊断与 COPD-PH 或 ILD-PH 之间无显著差异。肺功能检查未能在 SPH 诊断中明确显示出明确的表型。
在调整分析中，与根据 SPH 诊断列出的患者相比，当列出间质性肺病时，晚期肺病和继发性 PH 患者更有可能接受移植。SPH 诊断在临床上过于混杂，无法在预测模型中使用，应考虑从 UNOS 中删除。
