Clinical lung and heart/lung transplantation
Effect of Preoperative Pulmonary Artery Pressure on Early Survival After Lung Transplantation for Idiopathic Pulmonary Fibrosis

https://doi.org/10.1016/j.healun.2004.10.014Get rights and content

Background

Idiopathic pulmonary fibrosis (IPF) is the second largest indication for lung transplantation worldwide. Average 90-day mortality rates for this procedure are 22%. It is unclear what factors predispose patients with IPF to this increased early posttransplant mortality. Pulmonary hypertension may increase the risk of development of early posttransplant complications through several mechanisms. We examined the effect of secondary pulmonary hypertension on 90-day mortality after lung transplantation for IPF.

Methods

An International Society for Heart and Lung Transplant Registry cohort study of 830 patients with IPF transplanted from January 1995 to June 2002 was undertaken. Risk factors were assessed individually and adjusted for confounding by a multivariable logistic regression model.

Results

In the univariate analysis, pulmonary hypertension and bilateral-lung transplantation were significant risk factors for increased 90-day mortality. Multivariate analysis confirmed that mean pulmonary artery pressure and bilateral procedure remain independent risk factors after adjustment for potential confounders. Recipient age, ischemia time, cytomegalovirus status mismatch, and donor age were not independent risk factors for early mortality.

Conclusions

Bilateral-lung transplantation carries a greater risk of early mortality than single-lung transplantation for IPF. Increasing pulmonary artery pressure is a risk factor for death after single-lung transplantation in IPF. Mean pulmonary artery pressure should be included in the overall risk assessment of patients with IPF evaluated for lung transplantation.

Section snippets

Design

The study was a retrospective cohort study that used the ISHLT registry database.

Patients

All adult patients who underwent lung transplantation from January 1, 1995, to June 30, 2002, with a diagnosis of IPF were eligible for inclusion. Patients with multiorgan transplants were excluded from the analysis because we thought that they would not be representative of the average IPF population undergoing lung transplantation. In addition, patients with unknown status at 90 days were also excluded from the

Results

From January 1, 1995, to June 30, 2002, a total of 1590 adult patients underwent lung transplantation for advanced lung disease due to IPF. Ninety-two patients were excluded because of unknown patient status at 90 days, and one was excluded because of multiorgan transplant. A total cohort of 1497 adult patients with IPF underwent lung transplantation and had 90-day follow-up reported. Of these, 667 patients did not have documented PA pressure data. This left a final cohort of 830 patients

Discussion

IPF accounts for approximately 20% of the advanced lung diseases that ultimately are treated with lung transplantation. The perioperative and long-term survival rates for patients with IPF are worse than the other most common indications for lung transplantation, emphysema and cystic fibrosis.10 The majority of long-term survival differences among these advanced lung diseases is because of significantly increased early posttransplant mortality in IPF. This group of patients may receive a

References (40)

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