BACKGROUND

The optimal transplant strategy for patients with end-stage lung disease complicated by secondary pulmonary hypertension (PH) is controversial. The aim of this study is to define the role of single lung transplantation in this population.

METHODS

We performed a retrospective study of lung transplant recipients using the Organ Procurement and Transplantation Network/United Network for Organ Sharing Standard Transplant Analysis and Research registry. Adult recipients that underwent isolated lung transplantation between May 2005 and June 2015 for end-stage lung disease because of obstructive or restrictive etiologies were identified. Patients were stratified by mean pulmonary artery pressure ([mPAP] ≥ or < 40 mm Hg) and by treatment—single (SOLT) or bilateral (BOLT) orthotopic lung transplantation. The primary outcome measure was overall survival (OS), which was estimated using the Kaplan-Meier method and compared by the log-rank test. To adjust for donor and recipient confounders, Cox proportional hazards models were developed to estimate the adjusted hazard ratio of mortality associated with elevated mPAP in SOLT and BOLT recipients.

RESULTS

A total of 12,392 recipients met inclusion criteria. Of recipients undergoing SOLT, those with mPAP ≥40 were shown to have lower survival, with 5-year OS of 43.9% (95% confidence interval 36.6–52.7; p = 0.007). Of recipients undergoing BOLT, OS was superior to SOLT, and no difference in 5-year OS between mPAP ≥ and <40 was observed (p = 0.15). In the adjusted analysis, mPAP ≥40 mm Hg was found to be an independent predictor for mortality in SOLT, but not BOLT recipients. This finding remained true on multivariable analysis. In patients undergoing SOLT, mPAP ≥40 was associated with an adjusted hazard ratio for mortality of 1.31 (1.08–1.59, p = 0.07). In BOLT, mPAP was not associated with increased hazard (adjusted hazard ratio 1.04, p = 0.48).

CONCLUSIONS

There is a reduced survival when a patient with severe secondary PH undergoes SOLT. This increased mortality hazard is not seen in BOLT. It appears that a BOLT may negate the adverse effect that severe PH has on OS, and may be superior to SOLT in patients with mPAP over 40 mm Hg.

中文翻译：

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重度继发性肺动脉高压患者的单肺移植。

背景

终末期肺部疾病并发继发性肺动脉高压（PH）的患者的最佳移植策略尚存争议。本研究的目的是确定单肺移植在该人群中的作用。

方法

我们使用器官采购和移植网络/器官共享标准移植分析和研究注册联合网络对肺移植接受者进行了回顾性研究。确定了2005年5月至2015年6月因阻塞性或限制性病因而接受终末期肺疾病隔离肺移植的成年接受者。通过平均肺动脉压（[mPAP]≥或<40 mm Hg）和通过治疗（单次（SOLT）或双侧（BOLT）原位肺移植）对患者进行分层。主要结局指标是总体生存期（OS），使用Kaplan-Meier方法估算并通过对数秩检验进行比较。为了适应捐赠者和接受者的混杂因素，

结果

共有12,392名接受者符合入选标准。在接受SOLT的接受者中，mPAP≥40的接受者生存率较低，5年OS为43.9％（95％置信区间36.6-52.7；p  = 0.007）。在接受BOLT的接受者中，OS优于SOLT，并且在mPAP≥和<40之间的5年OS中没有观察到差异（p  = 0.15）。在校正后的分析中，发现mPAP≥40 mm Hg是SOLT死亡率的独立预测因子，但不是BOLT接受者的死亡率。在多变量分析中，这一发现仍然是正确的。在接受SOLT的患者中，mPAP≥40与调整后的死亡率危险比为1.31（1.08–1.59，p  = 0.07）相关。在BOLT中，mPAP与增加的危险无关（调整后的危险比1.04，p = 0.48）。

结论

患有严重继发性PH的患者接受SOLT会降低生存率。在BOLT中看不到这种增加的死亡危险。似乎BOLT可以消除严重PH对OS的不利影响，并且在mPAP超过40 mm Hg的患者中可能优于SOLT。