The Impact of Severe Pulmonary Arterial Hypertension on Single Lung Transplantation in Patients with Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis: An Analysis of the UNOS Database

Abstract

Purpose Although double lung transplantation may offer a small survival advantage in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), single lung transplantation allows two patients to receive a life-saving intervention with excellent long-term results. However, there remains substantial hesitation to single lung transplantation in patients that also have severe pulmonary arterial hypertension (PAH), and outcomes in this population based on diagnosis have yet to be well described. Methods and Materials We retrospectively reviewed the United Network of Organ Sharing database for all single lung transplants between 1996 and 2011 performed for COPD or IPF. Demographic data, pre- and post-transplant characteristics, and outcomes were compared for this population based on the presence or absence of severe PAH by right heart catheterization (PASP >50mmHg). The primary outcome analyzed was all-cause mortality. Results 5,982 patients were identified (COPD, N=3,580; IPF, N=2,402). Severe PAH was present in 838 (23%) and 538 (22%) patients with COPD and IPF, respectively. For COPD, survival at 30 days, 1 year and 3 years was 94%, 80% and 60% in patients with severe PAH, and 97%, 85% and 67% without severe PAH (p=0.264). For IPF, survival at 30 days, 1 year and 3 years was 91%, 70% and 51% in patients with severe PAH, and 95%, 79% and 61% without severe PAH (p=0.001). Using a Cox proportional-hazards regression, severe PAH was an independent predictor of mortality in patients with IPF (HR=1.29, p Conclusions In this study, the presence of severe PAH was associated with an increased risk of mortality in patients with IPF, but not COPD. These results suggest that acceptable outcomes for single lung transplantation may be achieved in this population with COPD, but should be considered with caution in patients with IPF.