Lung transplantation for primary and secondary pulmonary hypertension

Background. Single lung transplantation (SLT) and bilateral lung transplant ation (BLT) are routinely performed in patients with primary pulmonary hype rtension (PPH) and secondary pulmonary hypertension (SPH). It is unclear wh ich procedure is preferable. We reviewed our experience with lung transplan ts for PPH and SPH to determine if any advantage exists with SLT or BLT for either PPH or SPH. Methods. We reviewed the outcomes of all lung transplants performed for PPH or SPH for 4.5 years (July 1995 to January 2000). Survival was reported by the Kaplan-Meier method, and log rank analysis was used to determine signi ficance. Statistical analyses of clinical data were performed using analysi s of variance and chi (2) analysis. Results. A total of 57 recipients met criteria for pulmonary hypertension w ith a mean pulmonary artery pressure of greater than or equal to 30 mm Hg. There were 15 patients with PPH and 40 patients with SPH. There were 6 pati ents who had SLTs and 9 patients who had BLTs in the PPH group; and there w ere 9 patients who had SLTs and 21 patients who had BLTs in the SPH group. We found a survival advantage for PPH patients who underwent BUS at all tim e points up to 4 years (100% vs 67%; p less than or equal to 0.02). There w as no dear advantage to SLTs or BLTs for SPH. At 4 years there was a trend toward improved survival with SLTs (91% vs 75%) in SPH patients with a mean pulmonary artery pressure less than or equal to 40 mm Hg (p less than or e qual to 0.11) with equivalent survival (80%) in patients with a mean pulmon ary artery pressure greater than or equal to 40 nun Hg. There was also a tr end toward improved survival in patients with a mean pulmonary artery press ure greater than or equal to 40 mm. Hg (PPH and SPH) with BLTs (88% vs 62%; p = 0.19). The incidence of rejection, infection, and other complications was comparable between SLTs and BLTs in each group. Conclusions. We believe that BLT is the procedure of choice for PPH. The pr ocedure of choice is less clear for SPH. Patients with SPH and a mean pulmo nary artery pressure greater than 40 nun Hg may benefit from a BLT and thos e with a mean pulmonary artery pressure less than or equal to 40 mm Hg may do better with an SLT; however, no clear advantage is seen. (C) 2001 by The Society of Thoracic Surgeons.