Similar Waitlist and Post-Lung Transplant Outcomes in Pulmonary Arterial Hypertension Patients When Compared with Other Etiologies of End-Stage Lung
Document Type
Article
Publication Date
4-1-2024
Publication Title
Journal of Heart and Lung Transplantation
Abstract
Purpose: In 2015 the lung transplantation (LT) allocation score was modified to better stratify end-stage pulmonary arterial hypertension (PAH) patients on the waitlist, as it was noted they were at a disadvantage with other lung transplant candidates.
Methods: Adult PAH patients registered for lung transplantation in the UNOS database from March 1, 2015 until June 30, 2022, were included in this study. Patients with PAH as the primary diagnosis were compared with all other diagnoses. Competing outcomes in the waitlist and post-transplant survival were compared among groups. Propensity matching was performed in both the waitlist and post-transplant.
Results: A total of 19423 patients were listed for LT during the study period. Of these 605 (3.1%) PAH and 18818 (96.9%) had other diagnoses. PAH patients were younger, had a higher lung allocation score (LAS) at listing, and had a lower cardiac index than other patients. PAH patients had increased cumulative incidence (CI) of death or delisting due to worsening clinical status (11% vs. 7.8%, p=0.005), and a lower CI of LT (74.8% vs. 81.1%, p<0.001). A total of 17074 patients received LT during the study period, of these 484 (2.8%) had PAH, and 16590 (97.2%) had other primary diagnoses. PAH patients were younger, more likely females, and had longer lengths of stay, more likely to be hospitalized at the time of LT. The one-year post-LT survival was lower in PAH patients (86%) when compared with other patients (89.3%, p=0.015). When PAH patients were propensity matched in the waitlist and after transplantation, all outcomes were similar with patients with another diagnosis.
Conclusion: End-stage PAH patients had worse outcomes on the waitlist and after LT, once clinical characteristics are matched, their outcomes are comparable with patients with other etiologies of end-stage lung disease.
Volume
43
Issue
4
First Page
S221
Last Page
S222
Recommended Citation
Krishnan S, Berjaoui W, Khirfan G, Shrestha N, Girgis R. Similar waitlist and post-lung transplant outcomes in pulmonary arterial hypertension patients when compared with other etiologies of end-stage lung. J Heart Lung Transplant. 2024 Apr;43(4):S221-S222.
