Switching from Heart-Lung to Double Lung Transplantations in Patients with Pre-Capillary Pulmonary Hypertension: A Monocentric Experience

PURPOSE Since 2007, extra-corporeal life support (ECLS) and national priority (NP) for organ allocation allowed to switch from heart-lung transplantation (HLT) to double lung transplantation (DLT) in most of patients with precapillary pulmonary hypertension (PH). Our objective was to determine whether switching a program of transplantation for PH from HLT to DLT provided acceptable outcomes. METHODS We performed a retrospective monocentric analysis of DLT or HLT for precapillary PH between 2007 and 2016; we excluded proportioned PH in group 3 and 5 as well as Eisenmenger syndrome; patients with corrected congenital heart diseases with severe PH were included. We reported the preoperative, operative and postoperative characteristics and re-transplantation free survival up to March 2019. We performed an univariate comparison of the data between period 1 (2007 to 2011) and period 2 (2012 to 2016). Re-transplantation-free survival were compared using Log-Rank test. We performed the same analysis in the subgroup of patients transplanted with NP status. RESULTS A total of 133 patients underwent 32 HLT and 101 DLT; 58 were performed during the period 1 and 75 during the period 2. The proportion of HLT decreased from 40% (period 1) to 12% (period 2) (p<0.01); whereas the proportion of transplantation in NP remained stable (60% vs. 63%, respectively, p=NS). Between the 2 periods, preoperative age, sex ratio, proportion of PH groups, hemodynamics and function were similar (all p=NS). Re-transplantation free survival was significantly increased in the period 2 (P=0.048). Among 82 patients transplanted in NP, 35 were transplanted in the period 1 and 47 in the period 2. The proportion of HLT decreased from 60% (period1) to 13% (period 2); whereas the proportions of hemodynamic compromise at transplantation (catecholamine or ECLS) were similar (71% vs. 74%, respectively, p=NS). Between the 2 periods, preoperative age, sex ratio, proportion of PH groups and hemodynamic were similar (all p=NS) in the NP subgroup; and re-transplantation free survival tended to improve in period 2 without reaching significance (p=0.068). CONCLUSION The proportion of HLT among patients transplanted for precapillary PH was divided by more than 3 within 10 years and was associated with better re-transplantation free survival.