Do Pulmonary Hypertensive Patients Have Worse Post Transplant Survival Than Non-Pulmonary Hypertensive Patients? An ISHLT Registry Analysis

Purpose Bilateral lung transplantation (BLTx) is beneficial for selective candidates including pulmonary hypertension (PH). Primary Arterial and other causes for pulmonary hypotension impact survival. Medical treatment with novel pharmaceuticals provided some amelioration but transplantation remains the long term means for survival. We hypothesized that early survival depends on primary versus secondary PH. Methods A retrospective review of ISHLT registry (05/06/2005 - 12/31/2016); follow up until 2018. The analysis was limited to BLTx patients > 18 yo, excluding multi-organ tx, redo tx, or lobar tx. Primary diagnosis divided as follows: Primary PH (PPH), Secondary PH excluding WHO class 1 (SPH), and non PH diseases. Age (ANOVA &let.03, sex chi sq. < .001) are significant. Results Patient subset had intraoperative mean PA pressures as follows: PPH (n=363) 56.7mmHg (sd 14.8), SPH (n=120) 40.6 (sd 16.0), non PH (n=12185), 28.6 (sd 11.8). ANOVA test between groups was < .001. Mean survival (days) for PPH (n=976) 2677 (CI 2530, 2824), SPH (n=173) 1953 (CI 1695, 2212), and non PH (n=27449) 2663.9 (CI 2633, 2893). Pairwise comparison log rank showed significance between PPH and SPH (chi sq. 11.8 p .001) and SPH non PH (18.0 p < .001). No difference between PPH and non-PH (.932 p=.334). Cumulative proportion surviving for PPH, SPH, and non-PH are 0.9, 0.87, 0.95 (sd err < .03) at 30 days respectively; 0.85, 0.83, 0.92 (sd err < .03) at 90 days; 0.8, 0.75, 0.85 (sd err < .03) at 365 days. Pairwise comparisons by Wilcoxon test was significant < .03 for all groups. Conclusion Despite lower survival at 90 days and 1 year, PPH does not have significantly worse long-term survival than non-PH (see KM curve for details). SPH has decreased early survival. The attrition rate continues to diverge from non-PH and PPH. The differences in outcome between PPH and SPH hold strong implications in the patient selection process Bilateral lung transplantation (BLTx) is beneficial for selective candidates including pulmonary hypertension (PH). Primary Arterial and other causes for pulmonary hypotension impact survival. Medical treatment with novel pharmaceuticals provided some amelioration but transplantation remains the long term means for survival. We hypothesized that early survival depends on primary versus secondary PH. A retrospective review of ISHLT registry (05/06/2005 - 12/31/2016); follow up until 2018. The analysis was limited to BLTx patients > 18 yo, excluding multi-organ tx, redo tx, or lobar tx. Primary diagnosis divided as follows: Primary PH (PPH), Secondary PH excluding WHO class 1 (SPH), and non PH diseases. Age (ANOVA &let.03, sex chi sq. < .001) are significant. Patient subset had intraoperative mean PA pressures as follows: PPH (n=363) 56.7mmHg (sd 14.8), SPH (n=120) 40.6 (sd 16.0), non PH (n=12185), 28.6 (sd 11.8). ANOVA test between groups was < .001. Mean survival (days) for PPH (n=976) 2677 (CI 2530, 2824), SPH (n=173) 1953 (CI 1695, 2212), and non PH (n=27449) 2663.9 (CI 2633, 2893). Pairwise comparison log rank showed significance between PPH and SPH (chi sq. 11.8 p .001) and SPH non PH (18.0 p < .001). No difference between PPH and non-PH (.932 p=.334). Cumulative proportion surviving for PPH, SPH, and non-PH are 0.9, 0.87, 0.95 (sd err < .03) at 30 days respectively; 0.85, 0.83, 0.92 (sd err < .03) at 90 days; 0.8, 0.75, 0.85 (sd err < .03) at 365 days. Pairwise comparisons by Wilcoxon test was significant < .03 for all groups. Despite lower survival at 90 days and 1 year, PPH does not have significantly worse long-term survival than non-PH (see KM curve for details). SPH has decreased early survival. The attrition rate continues to diverge from non-PH and PPH. The differences in outcome between PPH and SPH hold strong implications in the patient selection process