Lung Transplantation for Pulmonary Hypertension
Medical > Therapy > Operative treatments
Lung Transplantation for Pulmonary Hypertension
Lung transplantation has become in the past ten years a real therapeutic alternative for disabling lung disease which can not be releaved by more conservative treatment. Since 1992, more than 180 transplantations have been performed in Switzerland with an overall 60 % survival rate at 5 years. Pulmonary hypertension accounted for 15 % of the indications half of which were primary pulmonary hypertension and the other have been secondary to diseases such as chronic thromboembolic diseases or Eisenmenger syndrome. Also patients with systemic sclerosis and pulmonary hypertension may be considered for lung transplantation.
The short term prognosis has been slightly worse for pulmonary hypertension than for the other indications of lung transplantation. This can be explained by difficulties encountered by the operating and anaesthetist teams related to the induction of narcosis, the extracorporeal circulation and the reanimation of these patients which have a severe failure of their right heart. Several adaptations have been performed to avoid these difficulties such as the continuous use of transoesophageal echocardiography during the transplantation which have markedly improved the cardiac monitoring during the procedures. Other adaptations during the post operative period have improved our current results. One has to know that moderate to severe right heart failure is usually not a contraindication for bilateral lung transplant whereas a left ejection fraction lower than 40 % is for most group an indication to perform an heart lung transplantation. Indeed once transplantation has been performed, the right heart recovers usually its function after three to four weeks, with a simultaneous correction of the interactions of the right dilated ventricle on the left ventricle.
Like for other transplantations, patients will have to comply to the medical controls which are weekly the first three months to become monthly beyond 6 months for most patients.
Medicines against rejection and one or two drugs to prevent infections are usually prescribed life long. This is the price for maintaining a good quality of life and a good graft function for two thirds of patients beyond 5 years at the present stage of our current practice.
Some forms of pulmonary hypertension specially those which are primary in nature, have a prognosis which is of less than 50 % survival after 2 years, if they don't respond to currents treatments. These patients and their physicians should than not wait too long before contemplating lung transplantation. Indeed the time on waiting list is easily of 3 to 9 months and some patients are enlisted too late to be able to benefit of lung transplantation, even with the support of treatment such as prostacyclines.
www.ishlt.org
www.swisstransplant.org
Back to > Medical > Therapy > Operative treatments
Lung Transplantation for Pulmonary Hypertension
Lung transplantation has become in the past ten years a real therapeutic alternative for disabling lung disease which can not be releaved by more conservative treatment. Since 1992, more than 180 transplantations have been performed in Switzerland with an overall 60 % survival rate at 5 years. Pulmonary hypertension accounted for 15 % of the indications half of which were primary pulmonary hypertension and the other have been secondary to diseases such as chronic thromboembolic diseases or Eisenmenger syndrome. Also patients with systemic sclerosis and pulmonary hypertension may be considered for lung transplantation.
The short term prognosis has been slightly worse for pulmonary hypertension than for the other indications of lung transplantation. This can be explained by difficulties encountered by the operating and anaesthetist teams related to the induction of narcosis, the extracorporeal circulation and the reanimation of these patients which have a severe failure of their right heart. Several adaptations have been performed to avoid these difficulties such as the continuous use of transoesophageal echocardiography during the transplantation which have markedly improved the cardiac monitoring during the procedures. Other adaptations during the post operative period have improved our current results. One has to know that moderate to severe right heart failure is usually not a contraindication for bilateral lung transplant whereas a left ejection fraction lower than 40 % is for most group an indication to perform an heart lung transplantation. Indeed once transplantation has been performed, the right heart recovers usually its function after three to four weeks, with a simultaneous correction of the interactions of the right dilated ventricle on the left ventricle.
Like for other transplantations, patients will have to comply to the medical controls which are weekly the first three months to become monthly beyond 6 months for most patients.
Medicines against rejection and one or two drugs to prevent infections are usually prescribed life long. This is the price for maintaining a good quality of life and a good graft function for two thirds of patients beyond 5 years at the present stage of our current practice.
Some forms of pulmonary hypertension specially those which are primary in nature, have a prognosis which is of less than 50 % survival after 2 years, if they don't respond to currents treatments. These patients and their physicians should than not wait too long before contemplating lung transplantation. Indeed the time on waiting list is easily of 3 to 9 months and some patients are enlisted too late to be able to benefit of lung transplantation, even with the support of treatment such as prostacyclines.
www.ishlt.org
www.swisstransplant.org
Back to > Medical > Therapy > Operative treatments
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SSPH Research Prize 2012
Deadline for submission: April 30, 2012
Further information
Symposium "pulmonal-arterielle Hypertension im Kindesalter"
Donnerstag, 10. Mai 2012, 16.00-18.00, Bern
Further information:
5th International Congress of the Swiss Society of Pulmonary Hypertension (SSPH)
28.-29. September 2012, Thun, Congress Hotel Seepark Thun
Informationen: www.imk.ch/sgph2012
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