Transplantation for Idiopathic Pulmonary Arterial Hypertension: Improvement in the Lung Allocation Score Era
Open accessAbstract
Background—: Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poorly described. Methods and Results—: Adults diagnosed with idiopathic pulmonary arterial hypertension and listed for transplantation in the 80 months before and after the lung allocation score algorithm was implemented (n=1430) were identified in the United Network for Organ Sharing thoracic registry. Patients were stratified by organ listed and pre– and post–lung allocation score era. The cumulative incidences of transplantation and mortality for wait-listed patients in both eras were appraised with competing outcomes analysis. Posttransplantation survival was assessed with the Kaplan-Meier method. These analyses were repeated in propensity-matched subgroups. Cox proportional hazards analysis evaluated the effect of prelisting and pretransplantation characteristics on mortality. We found that patients in the post–lung allocation score era had significantly worse comorbidities; nevertheless, both lung transplantation and heart-lung transplantation candidates in this era enjoyed lower wait-list mortality and a higher incidence of transplantation in unmatched and propensity-matched analyses. On multivariable analysis, heart-lung transplantation and double-lung transplantation were associated with improved survival from the time of wait-listing, as was being listed at a medium- to high-volume institution. Donor/recipient sex matching predicted posttransplantation survival. Conclusions—: The incidence of transplantation has increased while wait-list mortality has decreased in patients with idiopathic pulmonary arterial hypertension wait-listed for transplantation in the post–lung allocation score era. Both heart-lung transplantation and double-lung transplantation are predictive of survival in transplantation candidates with idiopathic pulmonary arterial hypertension, as is being listed at a medium- to high-volume institution. Donor/recipient sex matching is associated with better posttransplantation survival.
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In countries where lung allocation scores do not fully capture waitlist mortality for pulmonary arterial hypertension, early transplant consideration is particularly important.
“This issue is of particular importance in countries where a lung allocation system utilizes a score that does not fully capture the waitlist mortality for individuals with PAH (276–280).”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [277]
In “Listing IPAH Patients for Transplantation” (page unavailable), the paper says whether the lung allocation score gives these patients appropriate priority remains controversial and warns that listing too late can mean dying while waiting. It does not assess allocation systems across countries or specifically recommend early transplant consideration in countries whose scores underrepresent waitlist mortality. (LLM, conf=0.83)
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References 51 · Cited by 69
- Authors
- Schaffer, J. M., Singh, S. K., Joyce, D. L., Reitz, B. A., Robbins, R. C., Zamanian, R. T., & Mallidi, H. R.
- Affiliations
- Baylor College of Medicine (US)
- Venue
- Circulation
- Published
- 2013-06-25
- Volume
- 127
- Issue
- 25
- Pages
- 2503-2513
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2059704493
- Semantic Scholar
- e9877e3d8e22f8a2d695b50188b0411efec619c3
- Cited by
- 69
- References
- 51
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2022: 7 · 2021: 10 · 2020: 3 · 2019: 1 · 2018: 8 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 9 · 2013: 5
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- idiopathic pulmonary arterial hypertension, lung transplantation, heart-lung transplantation, lung allocation score, transplant waitlisting, post-transplant survival, donor-recipient sex matching, transplant center volume, organ allocation policy
- MeSH terms
- Adult, Algorithms, Female, Humans, Hypertension, Pulmonary, Male, Middle Aged, Tissue and Organ Procurement, Registries, Retrospective Studies, Time Factors, Waiting Lists, Health Care Rationing, Incidence, Survival Rate, Proportional Hazards Models, Heart Transplantation, Lung Transplantation, Treatment Outcome, Kaplan-Meier Estimate, Familial Primary Pulmonary Hypertension
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