Key result
~31% of eligible NYHA class IV PAH patients die without receiving a lung transplant.
Cohort (n=1,391)
Yes
Absolute Event Rate: 8.3% vs 30.6%
p-value: p=0.017
Lung and heart-lung transplantation may be underutilized in severe pulmonary arterial hypertension, with patients in functional class IV being less likely to receive a transplant.
May indicate underutilization of lung transplantation in severe PAH; leaves open whether enhanced referral strategies improve access and outcomes.
BACKGROUND: Real use of lung (LT) and heart-lung (HLT) transplantation in pulmonary arterial hypertension (PAH) is unknown. The objectives were to describe the indication of these procedures on PAH treatment in a national cohort of PAH patients, and to analyze the potential improvement of its indication in severe patients. METHODS: Eligibility for LT/HLT was assessed for each deceased patient. Incident patients from REHAP diagnosed between January 2007 and March 2015 and considered eligible for LT/HLT were grouped as follows: those who finally underwent transplantation (LTP) and those who died (D-Non-LT). FINDINGS: Of 1391 patients included in REHAP, 36 (3%) were LTP and 375 (27%) died. Among those who died, 36 (3%) were D-Non-LT. LTP and D-Non-LT were equal in terms of age, gender, and clinical status. Ten percent of those who died were functional class I-II. Patients functional class IV were less likely to undergo LT (8.3% LTP vs. 30.6% D-Non-LT, p = 0.017). Patients with idiopathic and drug/toxin-associated PAH were more likely to undergo LT (44.4% LTP vs. 16.7% D-Non-LT, p = 0.011). CONCLUSIONS: The present results show that the use of LT/HLT could double for this indication. Relevant mortality in early functional class reflects the difficulties in establishing the risk of death in PAH.
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López‐Meseguer et al. (2017) conducted a cohort in Pulmonary arterial hypertension (n=1,391). Lung or heart-lung transplantation vs. Death without transplantation (potentially eligible patients) was evaluated on Proportion of patients in NYHA functional class IV (p=0.017). In a national cohort of patients with pulmonary arterial hypertension, only 2.6% underwent lung transplantation, and eligible patients in NYHA functional class IV were significantly less likely to receive a transplant than to die without one (8.3% vs 30.6%, p=0.017).
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