Living-Donor Lobar Lung Transplantation for Pulmonary Arterial Hypertension After Failure of Epoprostenol Therapy

Hiroshi Date, Kengo Fukushima Kusano, Hiromi Matsubara, Aiko Ogawa, Hideki Fujio, Katsumasa Miyaji, Megumi Okazaki, Masaomi Yamane, Shinichi Toyooka, Motoi Aoe, Yoshifumi Sano, Motohiko Hanazaki, Keiji Goto, Shingo Kasahara, Shunji Sano, Tohru Ohe

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Abstract

Objectives: The aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment. Background: Although continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy. Methods: From July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients. Results: There was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 ± 4 mm Hg to 15 ± 2 mm Hg (p <0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100% at 5 years for patients receiving LDLLT, and 80% at 1 year, 67% at 3 years, and 53% at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles. Conclusions: These follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.

Original languageEnglish
Pages (from-to)523-527
Number of pages5
JournalJournal of the American College of Cardiology
Volume50
Issue number6
DOIs
Publication statusPublished - Aug 7 2007

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Lung Transplantation
Living Donors
Epoprostenol
Pulmonary Hypertension
Therapeutics
Critical Illness
Pulmonary Artery

ASJC Scopus subject areas

  • Nursing(all)

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Living-Donor Lobar Lung Transplantation for Pulmonary Arterial Hypertension After Failure of Epoprostenol Therapy. / Date, Hiroshi; Kusano, Kengo Fukushima; Matsubara, Hiromi; Ogawa, Aiko; Fujio, Hideki; Miyaji, Katsumasa; Okazaki, Megumi; Yamane, Masaomi; Toyooka, Shinichi; Aoe, Motoi; Sano, Yoshifumi; Hanazaki, Motohiko; Goto, Keiji; Kasahara, Shingo; Sano, Shunji; Ohe, Tohru.

In: Journal of the American College of Cardiology, Vol. 50, No. 6, 07.08.2007, p. 523-527.

Research output: Contribution to journalArticle

Date, H, Kusano, KF, Matsubara, H, Ogawa, A, Fujio, H, Miyaji, K, Okazaki, M, Yamane, M, Toyooka, S, Aoe, M, Sano, Y, Hanazaki, M, Goto, K, Kasahara, S, Sano, S & Ohe, T 2007, 'Living-Donor Lobar Lung Transplantation for Pulmonary Arterial Hypertension After Failure of Epoprostenol Therapy', Journal of the American College of Cardiology, vol. 50, no. 6, pp. 523-527. https://doi.org/10.1016/j.jacc.2007.03.054
Date, Hiroshi ; Kusano, Kengo Fukushima ; Matsubara, Hiromi ; Ogawa, Aiko ; Fujio, Hideki ; Miyaji, Katsumasa ; Okazaki, Megumi ; Yamane, Masaomi ; Toyooka, Shinichi ; Aoe, Motoi ; Sano, Yoshifumi ; Hanazaki, Motohiko ; Goto, Keiji ; Kasahara, Shingo ; Sano, Shunji ; Ohe, Tohru. / Living-Donor Lobar Lung Transplantation for Pulmonary Arterial Hypertension After Failure of Epoprostenol Therapy. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 6. pp. 523-527.
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abstract = "Objectives: The aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment. Background: Although continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy. Methods: From July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients. Results: There was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 ± 4 mm Hg to 15 ± 2 mm Hg (p <0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100{\%} at 5 years for patients receiving LDLLT, and 80{\%} at 1 year, 67{\%} at 3 years, and 53{\%} at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles. Conclusions: These follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.",
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AU - Date, Hiroshi

AU - Kusano, Kengo Fukushima

AU - Matsubara, Hiromi

AU - Ogawa, Aiko

AU - Fujio, Hideki

AU - Miyaji, Katsumasa

AU - Okazaki, Megumi

AU - Yamane, Masaomi

AU - Toyooka, Shinichi

AU - Aoe, Motoi

AU - Sano, Yoshifumi

AU - Hanazaki, Motohiko

AU - Goto, Keiji

AU - Kasahara, Shingo

AU - Sano, Shunji

AU - Ohe, Tohru

PY - 2007/8/7

Y1 - 2007/8/7

N2 - Objectives: The aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment. Background: Although continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy. Methods: From July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients. Results: There was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 ± 4 mm Hg to 15 ± 2 mm Hg (p <0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100% at 5 years for patients receiving LDLLT, and 80% at 1 year, 67% at 3 years, and 53% at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles. Conclusions: These follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.

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