PURPOSE: Recent studies suggest that bilateral lung transplantation (BLT) has worse outcomes than single lung transplantation (SLT) in IPF patients. Pulmonary hypertension in patients with IPF can lead to poor post-transplant outcomes. Most IPF patients with pulmonary hypertension receive BLT. Furthermore, prior studies have utilized PAP measured at different times prior to transplantation. The current study was undertaken to assess the interaction of intraoperative PAP with type of transplant on outcomes.
METHODS: A retrospective review of transplant recipients with IPF at the University of Pennsylvania, the University of Alabama, Duke University and the Ochsner Clinic was undertaken. Intraoperative PAP was utilized for the study and demographic data were obtained. Patients were divided in groups based on median PAP and type of transplant. Survival was estimated by the Kaplan-Meier method and the log-rank test compared survival plots across groups. Cox proportional hazards models were used to assess the interaction between other variables and survival.
RESULTS: Of 260 patients that met our criteria, 95 (36.5%) underwent BLT and 172 (66.2%) were male. Mean pulmonary artery pressure (MPAP) was 25.8±11.8, mean pulmonary artery diastolic pressure (PADP) was 18.8±9.7 and mean pulmonary artery systolic pressure (PASP) was 39.8±18.0. There were no differences in survival between patients receiving BLT vs. SLT and having MPAP above or below 23mmHg, as can be seen on the figure (p=0.851). Multivariable analysis showed that increasing PASP had a negative effect, while increasing PADP had a protective effect on post-transplant survival (for each 10mmHg increase in PASP: 1.24 (1.04-1.47); in PADP: 0.69 (0.50-0.97)). Type of transplant was not a significant predictor of survival.
CONCLUSION: BLT and SLT have similar outcomes in patients with IPF even when PAP is taken into account.
CLINICAL IMPLICATIONS: BLT or SLT can be used for patients with IPF undergoing lung transplantation. Further studies are needed to determine whether one operation is preferred over the other in certain groups of patients.
DISCLOSURE: Denis Hadjiliadis, None.