Survival outcomes with bilateral lung vs heart-lung transplantation for pulmonary arterial hypertension

Results from an analysis of the United Network for Organ Sharing (UNOS) registry, comparing outcomes of bilateral lung (n = 776) vs heart-lung transplantation (n = 138) in adults with primary pulmonary arterial hypertension (PAH), were published in The Journal of Heart and Lung Transplantation by Zarrabian et al. The primary endpoint was all-cause mortality (ACM) at 1 year, with 5‑year ACM as the secondary endpoint. 

Key data: In multivariable analysis, heart-lung transplantation was not associated with higher 1‑year ACM vs bilateral lung transplantation (adjusted hazard ratio [aHR], 1.82; 95% confidence interval [CI], 0.89–3.72; p = 0.10); 5‑year ACM was also comparable between groups (aHR, 1.49; 95% CI, 0.87–2.54; p = 0.14). Findings were consistent across hemodynamic subgroups. During follow-up, 44.4% of the overall cohort died, with unadjusted mortality higher among heart-lung recipients than bilateral lung recipients (55.1% vs 42.7%); however, median survival was longer with heart-lung transplantation in unadjusted analyses (1,005 vs 705 days; p = 0.04). 

Key learning: Bilateral lung transplantation was associated with comparable 1- and 5‑year survival to heart-lung transplantation in patients with PAH, supporting its role as a viable alternative in appropriately selected patients.