Ten years experience with lung and heart-lung transplantation in primary and secondary pulmonary hypertension

Objective: Patients with primary pulmonary hypertension (PPHT) have a worse natural outcome compared with those with secondary pulmonary hypertension in Eisenmenger's syndrome (ES) and chronic pulmonary embolism (CPE). Lung transplantation (SLTx, DLTx, HLTx) still remains the only therapeutical option for patients with this type of endstage lung disease. Methods: From 1988 to 1998, 63 patients underwent lung transplantation for PPHT(n = 29, 9 m, 20 f, 2 SLTx, 14 DLTx, 13 HLTx), ES (n = 29, 13 m, 16 f, 2 SLTx, 3 DLTx, 24 HLTx) or CPE (n = 5, 2 m, 3 f, 1 SLTx, 2 DLTx, 2 HLTx). Groups were comparable for NYHA functional dass, preoperative pulmonary arterial pressure, recipient and donor age, ischemic time, necessity and duration of cardiopulmonary bypass and cross-match. Results: The 1-, 3- and 5-year survival was 52, 40 and 35% for the PPHT-group, 83, 78 and 74% for the ES-group and 80, 60 and 60% for the CPE-group, respectively (P = 0.026, P = 0.033, P = 0.082 for 1-, 3- and 5-year survival). Patients following DLTx showed a lower I-year survival rate as compared with patients after HLTx both in PPHT patients (36 vs. 62%. P = 0.091) and in ES patients (67 vs. 83%, P = 0.213). The incidence of bronchiolitis obliterans syndrome was 29% at 1 year and 45% at 3 years for the PPHT-group vs. 17 and 65% for the ES-group (n.s, in between groups). Excluding postoperative ventilation time (PPHT-group: 26.8 +/- 24.0 days vs. ES-group: 16.1 +/- 30.8 days, P = 0.011) and a higher incidence of infectious causes of death (PPHT-group n = 8 vs. ES-group II = 1, P = 0.017) groups were comparable with regard to their postoperative courses. Conclusions: It is concluded, that predominantly the underlying primary disease influences graft survival after lung transplantation in patients with pulmonary hypertension compared with all other patient and procedure dependent factors. Lung transplantation in patients with PPHT requires further investigations to achieve results comparable with other indications. (C) 2000 Elsevier Science B.V. All rights reserved.