"Changes in Lung Transplant Waitlist Outcomes for Primary Pulmonary Hyp" by Reda E. Girgis, Sheila Krishnan et al.
 

Changes in Lung Transplant Waitlist Outcomes for Primary Pulmonary Hypertension (PPH) After Revision of Lung Allocation System: A UNOS Analysis

Document Type

Article

Publication Date

4-2024

Publication Title

The Journal of Heart and Lung Transplantation

Abstract

Purpose: Idiopathic pulmonary arterial hypertension (formerly PPH) continues to have a high mortality rate despite medical therapy. Lung Transplant (LTX) is an important option to prolong survival. Institution of the lung allocation score (LAS) in the US in 2005 resulted in dramatic increases in transplant rates and reduction in mortality for all diagnostic groups, but waitlist mortality remained high for PPH relative to other conditions. In 2015, the LAS was revised to better reflect severity of disease in PPH. We sought to compare rates of transplant and waitlist mortality for PPH before and after the revision. Methods: Bilateral lung transplant adult recipients from May 2005 to May 2021 with listing diagnosis of PPH were included. Multi-organ recipients were excluded. A competing events analysis compared transplant and death or removal on the waitlist one year after listing before (old era) vs. after (new era) the LAS revision date of March 1, 2015. Results: A total of 948 subjects were included, 440 in the old era and 508 in the new era. Pulmonary hemodynamics were similar between the two groups. New era candidates were slightly older (48.3 vs. 45.8 years; p=0.003) and a higher proportion required ECMO support at listing (5.3 vs. 0.9%). The cumulative incidence of transplant at 1 year after listing was 73% in the new era vs. 49% in the old era (p<0.001) and that of death or removal on the waitlist was 12% vs. 22%, respectively (p<0.001). After covariate adjustment the hazard ratio for transplant after 1 year was 2.1 for new era (p<0.001) and 0.39 for death or removal from the waitlist (p< 0.001) (figure). Conclusion: Revision of the LAS has been accompanied by an increase in the number of transplants performed for PPH. The likelihood of transplant at 1-year after listing was significantly increased in the new era, while the likelihood of death or removal from the waitlist was reduced. The impact of new modifications in the allocation system on waitlist outcomes of PPH will need to be assessed.

Volume

43

Issue

4 Supplement

First Page

S314

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