E J Pielsticker1, F J Martinez, M Rubenfire. 1. Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor 48106-0363, USA.
Abstract
BACKGROUND: Transplant practice patterns for pulmonary hypertension in the epoprostenol era are unknown. METHODS: Thirty-five centers in North America, Europe, and Israel were surveyed regarding practice patterns for lung and heart-lung transplant. RESULTS: New York Heart Association class and distance on a 6-minute walk were considered most useful for deciding who to refer for listing. Patients with New York Heart Association class I to II were referred for listing in 26% of centers, while 57% were classified as New York Heart Association class III or greater after epoprostenol failure. Twenty-nine of the 35 centers had transplant programs that performed approximately 75% of the International Registry volume annually. A double lung transplant was preferred by 83% of centers and heart-lung transplant in the remaining centers. The wait time for lung transplant averaged 16.8 months (range 4-36) and for heart-lung transplant averaged 21.3 months (range 6-36) and was significantly longer in the United States. The mean maximum age for heart-lung transplant was 51.4 years (range 35-65), double lung transplant 58.3 years (range 45-65), and single lung transplant 63.1 years (range 50-70). Fifty-three percent of centers transplant New York Heart Association class III or IV patients, 26% class IIIb-IV, and 21% only class IV. Eighty percent of centers use a transplant hold status. Major unqualified exclusions were hepatitis in 38%, 1 or more hepatic (90%) or renal (100%) criteria, smoking 97%, and obesity in 93%. CONCLUSIONS: Physicians and patients should be aware of the considerable variability in practice patterns for transplantation in pulmonary hypertension, despite published guidelines.
BACKGROUND: Transplant practice patterns for pulmonary hypertension in the epoprostenol era are unknown. METHODS: Thirty-five centers in North America, Europe, and Israel were surveyed regarding practice patterns for lung and heart-lung transplant. RESULTS: New York Heart Association class and distance on a 6-minute walk were considered most useful for deciding who to refer for listing. Patients with New York Heart Association class I to II were referred for listing in 26% of centers, while 57% were classified as New York Heart Association class III or greater after epoprostenol failure. Twenty-nine of the 35 centers had transplant programs that performed approximately 75% of the International Registry volume annually. A double lung transplant was preferred by 83% of centers and heart-lung transplant in the remaining centers. The wait time for lung transplant averaged 16.8 months (range 4-36) and for heart-lung transplant averaged 21.3 months (range 6-36) and was significantly longer in the United States. The mean maximum age for heart-lung transplant was 51.4 years (range 35-65), double lung transplant 58.3 years (range 45-65), and single lung transplant 63.1 years (range 50-70). Fifty-three percent of centers transplant New York Heart Association class III or IV patients, 26% class IIIb-IV, and 21% only class IV. Eighty percent of centers use a transplant hold status. Major unqualified exclusions were hepatitis in 38%, 1 or more hepatic (90%) or renal (100%) criteria, smoking 97%, and obesity in 93%. CONCLUSIONS: Physicians and patients should be aware of the considerable variability in practice patterns for transplantation in pulmonary hypertension, despite published guidelines.
Authors: Tomoko S Kato; Hilary F Armstrong; P Christian Schulze; Matthew Lippel; Atsushi Amano; Maryjane Farr; Matthew Bacchetta; Matthew N Bartels; Marco R Di Tullio; Shunichi Homma; Donna Mancini Journal: Am J Cardiol Date: 2015-05-21 Impact factor: 2.778
Authors: Kimberly Kallianos; Gabriel C Brooks; Kanae Mukai; Florent Seguro de Carvalho; Jing Liu; David M Naeger; Teresa De Marco; Karen G Ordovas Journal: Acad Radiol Date: 2017-08-31 Impact factor: 3.173