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Vol. 45. Issue 8.
Pages 366-370 (August 2009)
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Vol. 45. Issue 8.
Pages 366-370 (August 2009)
Original article
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Double-lung Transplantation in 15 Patients With Pulmonary Hypertension
Trasplante bipulmonar en hipertensión pulmonar. Una serie de 15 pacientes
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Manuel López-Meseguera, Antonio Romána,
Corresponding author
aroman@vhebron.net

Corresponding author.
, Víctor Monfortea, Carlos Bravoa, Joan Soléb, Ferran Morella
a Servei de Pneumologia, Hospital General Universitari Vall d’Hebron, Universitat Autonòma de Barcelona, CIBER de Enfermedades Respiratorias (CibeRes), Barcelona, Spain
b Servei de Cirurgia Toràcica, Hospital General Universitari Vall d’Hebron, Universitat Autonòma de Barcelona, CIBER de Enfermedades Respiratorias (CibeRes), Barcelona, Spain
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Abstract
Background

Pulmonary hypertension is a serious disease that, in its terminal phase, requires lung transplantation.

Patients and methods

A retrospective study was undertaken of 15 patients with pulmonary hypertension who underwent lung transplantation between 1994 and 2004.

Results

Pulmonary hypertension was reported as idiopathic in 8 patients (53%) and related to consumption of toxic oil in 2. The remaining causes were documented as chronic peripheral pulmonary embolism, histiocytosis X, venoocclusive disease, scleroderma, and simple corrected congenital heart defect in 1 patient each. The mean values of the hemodynamic variables were 100, 50, and 67mm Hg for systolic, diastolic, and mean pulmonary artery pressure, respectively; 2.63L/min for cardiac output; and 20.9 Wood units for total pulmonary resistance. The mean time between diagnosis of pulmonary hypertension and lung transplantation was 5.9 years (range, 0.4-20 y). Seven patients were in functional class III and 8 in functional class IV. The mean 6-minute walk distance was 204m (range, 0-360m). Four patients (26%) died during the during the perioperative period and 9 (60%), 7 (46%), and 6 (40%) were still alive at 1, 3, and 5 years, respectively.

Conclusions

Double-lung transplantation is a therapeutic option that, in certain cases, has similar outcomes to those achieved with the most aggressive medical treatment for pulmonary hypertension.

Keywords:
Pulmonary hypertension
Lung transplantation
Double-lung transplantation
Resumen
Introducción

La hipertensión pulmonar (HP) es una enfermedad grave tributaria de trasplante pulmonar (TP) en su fase terminal.

Pacientes y métodos

Se ha realizado un estudio retrospectivo de 15 pacientes con HP, a los que se trató con un TP en el período 1994–2004. Se revisan los datos clínicos antes del trasplante y el seguimiento tras éste.

Resultados

En 8 pacientes (53%) la HP fue idiopática y en 2 estuvo relacionada con el consumo de aceite tóxico; el resto de etiologías, con un paciente cada una, fueron: embolia pulmonar crónica periférica, histiocitosis X, enfermedad venooclusiva, esclerodermia y cardiopatía congénita simple corregida. Los valores hemodinámicos medios fueron: presión arterial pulmonar sistólica, diastólica y media, 100, 50 y 67mmHg, respectivamente; gasto cardíaco, 2,63l/min; resistencia pulmonar total, 20,9 UW. El tiempo desde el diagnóstico de HP hasta el TP fue de 5,9 (rango: 0,4-20) años. Siete pacientes estaban en clase funcional III y 8 en clase funcional IV. La distancia media recorrida en la prueba de la marcha de 6 min fue de 204m (rango: 0–360). La mortalidad perioperatoria fue de 4 pacientes (26%). La supervivencia a 1, 3 y 5 años fue de 9 (60%), 7 (46%) y 6 (40%) pacientes, respectivamente.

Conclusiones

El TP bilateral es una opción terapéutica que, en casos seleccionados, presenta resultados comparables al tratamiento médico más activo de la HP.

Palabras clave:
Hipertensión pulmonar
Trasplante pulmonar
Trasplante bipulmonar
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
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