Heart-lung transplantation: A viable option for connective tissue diseases

Clin Transplant. 2020 Feb;34(2):e13776. doi: 10.1111/ctr.13776. Epub 2020 Jan 9.

Abstract

Background: While lung transplantation (LTx) has been effective for connective tissue disease (CTD) patients with pulmonary involvement, outcomes for heart-lung transplantation (HLTx) are less defined. The aim of this study is to evaluate HLTx in CTD patients utilizing the UNOS database.

Methods: HLTx patients with CTD (HLTx-CTD) were compared to both LTx patients with CTD (LTx-CTD) and HLTx patients with all other indications (HLTx-OI) from 1999 to 2018. Primary outcome was 1- and 5-year graft survival. Secondary outcomes included freedom from first-year rejection and outcomes prior to transplant discharge.

Results: 1143/29 323 adults received first-time HLTx or LTx for CTD. Seventeen were HLTx-CTD (3.3% of total HLTx) and 1126 were LTx-CTD (3.9% of total LTx). There were 492 HLTx-OI. Transplant hemodynamic values including cardiac output, pulmonary capillary wedge pressure, and calculated pulmonary vascular resistance were significantly worse for HLTx-CTD vs LTx-CTD (4.2 vs 5.4 L/min, P = .005; 14 vs 10 mm Hg, P = .009; 439 vs 267 dynes, P = .007, respectively). Cardiac status 1 was more common for HLTx-CTD vs HLTx-OI (94% vs 56%, P < .001). HLTx-CTD 1 and 5-year graft survival was similar compared to LTx-CTD and HLTx-OI.

Conclusion: HLTx-CTD is a valid option for carefully selected patients with CTD cardiac and pulmonary involvement with similar morbidity and mortality compared to LTx-CTD and HLTx-OI.

Keywords: Sjogren's syndrome; UNOS review; connective tissue diseases; dermatomyositis; double organ transplantation; heart-lung transplantation; lung transplantation; mixed connective tissue disease; polymyositis; rheumatoid arthritis; scleroderma; systemic lupus erythematosus; systemic sclerosis; transplantation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Connective Tissue Diseases* / surgery
  • Databases, Factual
  • Graft Survival
  • Heart-Lung Transplantation*
  • Humans
  • Lung Transplantation*