Transplantation |

Short-term and Long-term Outcomes in Patients With Scleroderma and IPAH Undergoing Lung Transplant FREE TO VIEW

Shruti Gadre; Adriano Tonelli; Marie Budev; Syed Shah; Holli Blazey; Xiaofeng Wang; Omar Minai
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):979A. doi:10.1378/chest.1994781
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: There is little data regarding outcomes in patients with scleroderma (SSC) and idiopathic pulmonary arterial hypertension (IPAH) undergoing lung transplantation (LTXP) and the impact of pre-transplant recipient characteristics on these outcomes.

METHODS: Retrospective study of patients with SSC and IPAH undergoing LTXP between July 1992 and August 2013 at a single transplant center.

RESULTS: We evaluated 54 patients, 40.7% male; mean age 45.3 ±11.9 years, 42[78%] IPAH and 12[22%] SSC. 93% of IPAH patients underwent double lung or heart-lung transplant compared to 67% of the SSC group. Post transplant, 61.9% patients developed renal failure in the iPAH group compared to 45.5% in the scleroderma group (p=0.32). The mean duration of intubation was comparable in the two groups (7.7±5.6 vs 7.7±5.5 days; p=0.98). More patients were re-intubated and needed a tracheostomy in the scleroderma group compared to the iPAH group (81.8% vs 40.5%; p= 0.0146, 63.6% vs 40.5%; p=0.16 respectively). The mean duration of ICU stay was comparable in the two groups 19.7± 20.4 vs 18.1±12.2 days (p=0.62); as was the mean duration of hospital stay 42.2± 43.3 vs 37.5± 19.6 days (p=0.44). 100% patients with scleroderma survived the initial hospitalization compared to 95.2% patients with iPAH (p=0.44). 54.8% patients were discharged home in the iPAH group compared to 72.7 % in the scleroderma group (p=0.45). The overall mortality of the cohort at the end of the study period was high (n=21; 39.62%); 45.5% in the scleroderma group vs 38.1% in the iPAH group (p=0.65). Patients who died were more likely to be male (p=0.03), have elevated serum creatinine (p=0.56) and BNP (p=0.75), a lower cardiac index (p=0.40) and 6 minute walk distance (p=0.25), and had delayed heart rate recovery at 1 minute (p=0.34). Other than male gender, none of these factors reached statistical significance likely due to sample size.

CONCLUSIONS: In our cohort, patients with SSC had comparable short-term outcomes compared to patients with IPAH. These patients have a good outcome in the immediate post-transplant period however, the overall mortality is high.

CLINICAL IMPLICATIONS: Though not statistically significant due to small sample size, the study may help to identify pre transplant characteristics that predict outcomes in patients with SSC and IPAH undergoing transplant. This may help determine the best criteria for listing patients for LTXP.

DISCLOSURE: The following authors have nothing to disclose: Shruti Gadre, Adriano Tonelli, Marie Budev, Syed Shah, Holli Blazey, Xiaofeng Wang, Omar Minai

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