Heart-Lung vs Double-Lung Transplant Outcomes in Pulmonary Hypertension

Lung Transplant
Lung Transplant
Individuals with pulmonary hypertension experienced lower primary graft dysfunction following heart-lung transplantation compared with double-lung transplantation.

Individuals with pulmonary hypertension (PH) experienced lower primary graft dysfunction following heart-lung transplantation compared with double-lung transplantation, according to a study published in Transplant International. Rates of chronic lung allograft dysfunction-free and graft survival improved with more surgical experience.

This retrospective, single-center study included 38 individuals with heart-lung transplants and 30 individuals with double-lung transplants that took place between 1991 and 2014. These transplants were undertaken as a result of chronic thromboembolic PH (n=6), congenital heart disease (n=24), and connective tissue disease (n=4) as well as hepatoportal (n=1), drug-induced (n=9), heritable (n=2), and idiopathic (n=22) causes of precapillary PH. Post-discharge follow-up included ≥3 annual check-ups. A 2-tailed t-test was used to compare continuous variables, while the chi-square test was used to compare categorical variables. The Kaplan-Meier method was used to examine graft survival and chronic lung allograft dysfunction-free survival.

The use of heart-lung transplantation decreased from 91.7% to 21.4% between the beginning and end of the study period. Double-lung transplants were associated with more grade 2 and grade 3 primary graft dysfunction (P <.0001), while post-discharge bleeding occurred more frequently among heart-lung transplants (P =.06).  Graft survival for double-lung transplantation at 3 months was 93%, at 1 year was 83%, at 5 years was 70%, at 10 years was 47%, and at 15 years was 35%. For heart-lung transplantation, these rates were 82%, 74%, 61%, 48%, and 30%, respectively.

Rates of graft survival improved with surgical experience, with the 2010 to 2014 period showing significantly higher rates compared with the 1991 to 1995 period (P =.03). Chronic lung allograft dysfunction-free survival did not differ significantly, however, with double-lung transplantation 5- and 10-year rates at 80% and 28% vs heart-lung transplantation at 75% and 28% (P =.49). Heart-lung transplantation had a significantly longer follow-up than double-lung transplantation (234 vs 113 months, respectively; P <.0001).

This study was limited by its single-center, retrospective design; having a small population, a long study window, the potential for postoperative variables, and potential confounders that could not be retrieved as data. In addition, a changing indication for heart-lung transplantation over time which allowed for an imbalance in transplant type, longer follow-up for heart-lung transplantation that may have resulted in greater mortality rates, and a lack of analysis on risk-adjusted survival and risk factors may have also limited the study’s outcomes.

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The study researchers concluded that they “did not find any significant difference in early mortality, overall graft survival, and [chronic lung allograft dysfunction]-free survival between [heart-lung transplantation] and [double-lung transplantation]. There was a trend for more re-interventions for bleeding after [heart-lung transplantation], while [primary graft dysfunction] was more frequent, but manageable after [double-lung transplantation]. Graft survival in this high-risk group of PH patients has improved significantly over time with growing experience.”


Brouckaert J, Verleden SE, Verbelen T, et al. Double-lung versus heart-lung transplantation for pre-capillary pulmonary arterial hypertension; a 24-year single-center retrospective study [published online February 8, 2019]. Transpl Int. doi:10.1111/tri.13409

This article originally appeared on Pulmonology Advisor