Outcomes of heart-lung transplantation in Eisenmenger syndrome compared to primary pulmonary hypertension

Abstract

Objective

Heart-Lung Transplantation (HLTX) is required both in primary pulmonary hypertension (PPH) and Eisenmenger syndrome (ES) when there is associated end-stage heart disease. Although PPH is associated with an otherwise structurally normal heart, ES is associated with congenital heart defects, which may increase the complexity of the operation. This study analyzes if the diagnosis (PPH vs. ES) is related to short-term outcomes after HLTX.

Methods

Patients ≥18 years of age with PPH and ES who underwent HLTX were identified in the United Network for Organ Sharing database from 2005 to 2021. Patients were propensity score matched on heart and lung listing status at the time of transplant. Univariable, multivariable, and Kaplan–Meir survival analyses were performed.

Results

The unmatched cohort had 128 PPH and 44 ES patients, and the matched cohort had 44 patients in each group. PPH patients had lower waitlist times and PA pressures but higher FEV1, heart, and lung listing status and ECMO bridge. There were no differences in immediate postoperative outcomes such as dialysis, stroke, and airway dehiscence. PPH patients had a higher treatment rejection in the first year. The 30-day, 1-year, and 3-year survival were better in the PPH group. However, a landmark analysis excluding deaths within 30 days eliminated differences in survival between the groups. Post-transplant dialysis and postoperative mechanical ventilation >5 days were risk factors for 1-year mortality in ES.

Conclusion

The short-term outcomes of HLTX are inferior in ES compared to PPH and much of the attrition in ES occurs in the immediate postoperative period.

Keywords

Transplantation heart-lung (incl related subjects)cardiac congenital heart disease lung transplant thoracic pulmonary vascular resistance/hypertension

Get full access to this article

View all access options for this article.

References

Stoica

McNeil

Perreas

, et al. Heart-lung transplantation for Eisenmenger syndrome: early and long-term results. Ann Thorac Surg 2001; 72: 1887–1891.

Olland

Falcoz

Canuet

, et al.

Should we perform bilateral-lung or heart-lung transplantation for patients with pulmonary hypertension?

Interact Cardiovasc Thorac Surg 2013; 17: 166–170.

Bando

Armitage

Paradis

, et al. Indications for and results of single, bilateral, and heart-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1994; 108: 1056–1065.

Kosmidis

Firth

. Jeffreys-prior penalty, finiteness and shrinkage in binomial-response generalized linear models. Biometrika 2021; 108: 71–82.

George

Champion

Pilewski

. Lung transplantation for pulmonary hypertension. Pulm Circ 2011; 1: 182–191.

Frank

Hanna

. Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics. Minerva Pediatr 2015; 67: 169–185.

Wood

. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. I. Br Med J 1958; 2: 701–709.

Reitz

. The first successful combined heart-lung transplantation. J Thorac Cardiovasc Surg 2011; 141: 867–869.

Reitz

Wallwork

Hunt

, et al. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med 1982; 306: 557–564.

10.

Kramer

Valantine

Marshall

, et al. Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension. Am J Cardiol 1994; 73: 494–500.

11.

Fadel

Mercier

Mussot

, et al. Long-term outcome of double-lung and heart-lung transplantation for pulmonary hypertension: a comparative retrospective study of 219 patients. Eur J Cardiothorac Surg 2010; 38: 277–284.

12.

Conte

Borja

Patel

, et al. Lung transplantation for primary and secondary pulmonary hypertension. Ann Thorac Surg 2001; 72: 1673–1679; discussion 1679–1680.

13.

Toyoda

Thacker

Santos

, et al. Long-term outcome of lung and heart-lung transplantation for idiopathic pulmonary arterial hypertension. Ann Thorac Surg 2008; 86: 1116–1122.

14.

Sertic

Han

Diagne

, et al. Not all septal defects are equal: outcomes of bilateral lung transplant with cardiac defect repair vs combined heart-lung transplant in patients with Eisenmenger syndrome in the United States. Chest 2020; 158: 2097–2106.

15.

Waddell

Bennett

Kennedy

, et al. Heart-lung or lung transplantation for Eisenmenger syndrome. J Heart Lung Transplant 2002; 21: 731–737.

16.

Listing heart-lung candidates 05/06/2019. Available at: https://optn.transplant.hrsa.gov/news/listing-heart-lung-candidates/. Accessed 09 September 2021.

17.

OPTN Policies Effective as of Sept 1 2021 [Board Implementations] 09/01/2021. Available at: https://optn.transplant.hrsa.gov/media/eavh5bf3/optn_policies.pdf. Accessed 09 September 2021.

18.

Diller

G-P

Dimopoulos

Kafka

, et al. Model of chronic adaptation: right ventricular function in Eisenmenger syndrome. Eur Heart J 2007; 9: H54–H60.

19.

Mason

Solovera-Rozas

Feng

, et al. Dialysis after lung transplantation: prevalence, risk factors and outcome. J Heart Lung Transplant 2007; 26: 1155–1162.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB