A. Kashem1, S. Keshavamurthy1, M. N. Sakib1, J. Gomez-Abraham1, E. Leotta1, K. Minakata1, F. Cordova1, V. Dulam1, G. Ramakrishnan1, S. Brann1, Y. Toyoda1 1Temple University,Cardiothoracic Surgery,Philadelphia, PA, USA
Introduction: Patients diagnosed with Idiopathic pulmonary fibrosis (IPF) often demonstrate borderline and higher pulmonary hypertension (PH) with pulmonary artery mean pressure (PAP mean) below 25 mmHg and above 25 mmHg pressure. Many of these patients are candidates for either single or double lung transplantation. We investigated the survival outcome of IPF patients with <25 mmHg vs. >25 mmHg PAP mean who underwent a surgical procedure of single (SLT) or double lung transplantation (DLT).
Methods: 165 IPF patients that underwent either single or double LTx at our center from 2012 to 2016 were reviewed retrospectively. 86 patients had borderline PH with <25 mmHg PAP mean and 79 patients had PH with >25 mmHg PAP mean. Demographics, recipients’ age and height, donor age and height, LAS, length of stay (LOS), survival days, death, types of induction, and surgical procedures were compared between SLT vs DLT in IPF patients for significance in two groups of PAP mean (<25 vs. >25 mmHg). Actuarial survival was assessed by Kaplan-Meier curve and compared by log rank test. Data were expressed as mean ± standard deviation and p-value less than 0.05 was considered as statistically significant (Stata Inc.).
Results: Out of 165 IPG patients, group 1 with <25 mmHg PAP mean (n=86) had 32 DLT and 54 SLT procedures and group 2 with >25 mmHg PAP mean (n=79) had 48 DLT and 31 SLT procedures. Group 1 had 11 females with DLT vs. 13 with SLT compared to 21 males (70%M) with DLT and 41 males with SLT (p=0.303). Group 2 had 16 females with DLT vs. 8 with SLT compared to 32 males (72%M) with DLT and 23 males with SLT (p=0.478). In group 1, median length of stay is 16 days for SLT vs. 19 days for DLT procedure. In Group 2, median length of stay is 17 days for SLT vs. 20 days for DLT. Within groups 1 and 2, we compared incision types of antero-axillary, clamshell, and median sternotomy (p=0.001), induction type campath and simulect (p=0.241; p=0.824), and found no differences in BMI, race, donor age, and concomitant procedures. In group 1, recipient age had no differences 66 (SLT) vs. 66 (DLT); p=0.881 and in group 2, recipient age had no differences 67 (SLT) vs. 62 (DLT); p=0.996. There were significant differences in LAS in group 1, 50 (SLT) vs. 66 (DLT); p=0.001 and in group 2, 51 (SLT) vs. 69 (DLT); p=0.002. Kaplan-Meier curve showed no survival difference in SLT vs DLT in group 1 and 2 (fig 1).
Conclusion: Our results showed no differences in survival outcome with single or double lung transplantation when pulmonary artery mean pressure was below or above 25 mmHg in IPF patients.
