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

• Published in: Clinical transplantation 2020-02, Vol.34 (2), p.e13776-n/a
• Main Authors: Stern, Lily K., Selby, Van N., Kolaitis, Nicholas A., Boin, Francesco, Aras, Mandar, Klein, Liviu, De Marco, Teresa
• Format: Article
• Language: English
• Subjects: connective tissue diseases; dermatomyositis; double organ transplantation; heart‐lung transplantation; lung transplantation; mixed connective tissue disease; polymyositis; rheumatoid arthritis; scleroderma; Sjogren's syndrome; systemic lupus erythematosus; systemic sclerosis; transplantation; UNOS review
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13776

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