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VIENNA — Survival charges at 1 and 5 years for sufferers with pulmonary arterial hypertension (PAH) who obtain bilateral lung and heart-lung transplants are comparable, mentioned researchers presenting on the European Respiratory Society (ERS) 2024 International Congress.
Transplant for end-stage PAH stays an essential remedy possibility. Coronary heart-lung transplantation plummeted from 91.7% to 21.4% between 1991 and 2014. But in the USA and Europe, PAH is the second most typical motive to carry out a heart-lung transplant, Baharan Zarrabian, DO, a pulmonologist on the Mayo Clinic in Rochester, Minnesota, informed Medscape Medical Information.
Over the previous a long time, physicians have debated whether or not to go for a bilateral lung or a heart-lung transplant. Nevertheless, there’s at present an absence of definitive cardiac indicators to information the choice between the 2 procedures in sufferers with PAH.
Whereas the lung situation has cardiac ramifications, some specialists recommend that the guts can restore itself over time after a bilateral lung transplant.
No Survival Distinction Between Bilateral Lung and Coronary heart-Lung Transplants
Researchers in contrast the outcomes of bilateral lung transplantation with these of mixed heart-lung transplantation in sufferers with PAH. They used knowledge from the Organ Procurement and Transplantation Community, specializing in grownup sufferers with PAH with out congenital or structural cardiac abnormalities who underwent transplantation between June 2004 and September 2022.
The research included 918 sufferers, with the bulk (84.6%) receiving bilateral lung transplants and 15.4% receiving heart-lung transplants. Pretransplant imply pulmonary arterial strain and pulmonary vascular resistance had been comparable between the 2 teams. Nevertheless, those that acquired bilateral lung transplants had greater cardiac output and decrease pulmonary capillary wedge strain than those that acquired heart-lung transplants. A better proportion of heart-lung transplant recipients required extracorporeal membrane oxygenation (ECMO) earlier than transplantation, whereas bilateral lung transplant recipients had longer median ischemic occasions.
Regardless of these variations in pretransplant traits and surgical components, researchers discovered no important distinction in survival outcomes between the 2 teams on the 1-year and 5-year marks. Equally, graft survival charges at 1 and 5 years posttransplant didn’t differ considerably between the 2 teams.
A better proportion of sufferers who acquired bilateral lung transplant had been on ECMO and remained intubated at 72 hours. “That didn’t translate right into a worse end result afterward,” Zarrabian mentioned.
Cardiac Restoration Put up-Bilateral Lung Transplant
Saskia Bos, MD, PhD, a respiratory guide, lung transplant doctor, and transplant pulmonologist at College Hospitals Leuven, Leuven, Belgium, who was not concerned within the research, informed Medscape Medical Information that docs have traditionally most popular mixed heart-lung transplantation. The choice was motivated by a lack of awareness relating to whether or not the guts might rework by itself. “Now we all know that the appropriate ventricle, which is essentially the most affected a part of the guts in pulmonary hypertension, has an enormous potential to readapt to the brand new state of affairs after simply bilateral lung transplantation,” she mentioned.
Bos recommended that in circumstances the place a affected person has pulmonary hypertension with none structural coronary heart defects and the place the left aspect of the guts is functioning usually, docs can go for a bilateral lung transplant quite than a mixed heart-lung transplant. The proper ventricle, usually the one a part of the guts affected by the situation, can recuperate as soon as the pulmonary hypertension is addressed by way of lung transplantation, she defined.
The benefit of bilateral lung transplantation over a heart-lung transplant is that the donor’s coronary heart stays accessible for another person.
“The advice is that physicians go for a bilateral lung transplant,” Zarrabian concluded. “However we have to make that call on a case-by-case foundation as a result of we nonetheless do not know what are the cardiac parameters that we have to search for earlier than the transplant to determine whether or not or not they need to obtain a bilateral lung or a heart-lung.”
Zarrabian and Bos reported no related monetary relationships.
Manuela Callari is a contract science journalist specializing in human and planetary well being. Her phrases have been revealed in The Medical Republic, Uncommon Illness Advisor, The Guardian, MIT Expertise Evaluate, and others.
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