The survival rate of pulmonary hypertension patients who received heart and lung transplants increased after France began giving transplant priority to those experiencing life-threatening episodes, a study reports.
The high-priority list covered PH patients who had signed up for heart-lung transplants, or HLTs, and double lung transplants, or DLTs.
Researchers published their study, “Impact of High-Priority Allocation on Lung and Heart-Lung Transplantation for Pulmonary Hypertension,” in the journal Annals of Thoracic Surgery.
DLTs and HLTs are established treatments for patients with severe or end-stage PH. Compared with people with other conditions, PH patients fail to live as long after a transplant because of complications. In addition, while waiting for a transplant, they are at higher risk of dying due to right heart failure.
To try to decrease the deaths of PH patients on transplant waiting lists, many countries have revised their transplant allocation rules in the past decade.
French researchers wanted to see whether a high-priority list would increase the survival rate of those receiving transplants.
The study covered 234 patients with different forms of PH — pulmonary arterial hypertension (PAH), pulmonary veno-occlusive disease (PVOD), and chronic thromboembolic pulmonary hypertension (CTEPH). They were placed on a waiting list for a DLT or HLT at the Marie Lannelongue Hospital in Paris between 2000 and 2013. The year 2006 was six years before France inaugurated a high-priority list, and 2013 was six years after the priority system was introduced.
“In France, since September 2006 for HLT and July 2007 for DLT, waiting-list patients with cystic fibrosis, interstitial lung disease, or pulmonary hypertension (PH) who experience an event that remains immediately life-threatening, despite optimal treatment in the intensive care unit, are placed on a high-priority list (HPL) providing nationwide emergency access to transplants,” the researchers wrote. “A patient can be on the HPL for eight days, renewable once.”
Results showed that the death rate of PH patients who were on the waiting list dropped after France introduced the high-priority system. In addition, more patients received transplants. The percentages increased from 43 percent to 65 percent of those eligible after one year, and from 48 percent to 76 percent after two years.
A dramatic finding was that the percentage of transplant patients who survived for at least five years after a transplant doubled when the patients were on the priority list. Fifty-four percent survived after being placed on the list, versus 26 percent who were not on the list.
Creation of a high-priority list “for patients with end-stage PH was followed by a higher number of transplantations and lower waiting-list mortality rate,” the researchers concluded.