Pulmonary hypertension no bar to single-lung transplant

By David Douglas

NEW YORK (Reuters Health) - Pulmonary hypertension (PH) does not significantly affect outcome of single-lung transplantation, possibly increasing the number of potential recipients, according to Wisconsin-based researchers.

As Dr. Keith C. Meyer told Reuters Health by email, "The need for donor organs is much greater than the currently available supply. For many potential organ donors, two lungs are available for potential use, and performing two single-lung transplants can help two transplant candidates rather than using both lungs for one recipient by performing a bilateral lung transplant."

In a November 30 online paper in Thorax, Dr. Meyer and colleagues at the University of Wisconsin School of Medicine and Public Health, Madison, note that PH has been identified as a risk factor for complications. However, some investigators have not reported a difference in outcome between single and bilateral transplantation in patients with advanced lung disease-associated PH.

To investigate further, the researchers analyzed data on 279 patients who had undergone single-lung transplantation at their institution between 1999 and 2013. They were divided into four groups based on their mean pulmonary artery pressure values. These ranged from no PH in 150 patients to severe PH in 20.

Significantly more severe PH patients required cardiopulmonary bypass than did other patients, and they also required more extracorporeal membrane oxygenation. However, researchers found no differences in 30-day mortality, length of stay, or readmission among the four groups.

In addition they found no differences in long-term survival among the four groups, and the incidence of chronic lung allograft dysfunction was similar across groups.

Single-lung transplantation, continued Dr. Meyer, "may be a particularly good strategy to bolster the donor organ pool and help more patients, especially as more and more older/elderly patients with disorders such as idiopathic pulmonary fibrosis -- who frequently have significant pulmonary hypertension and generally have a very poor prognosis when they have advanced lung disease -- are getting listed for lung transplantation."

"Our point," he concluded, "is that when patients have pulmonary hypertension, even if relatively severe, giving them a single lung rather than a bilateral lung transplant can be done without risking both significantly increased short-term complications or long-term survival."

The National Cancer Institute and the George and Julie Mosher Pulmonary Research Fund partially supported this research.

SOURCE: https://bit.ly/1QoC3hP

Thorax 2015.