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Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient

Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allog...

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Autores principales: Housman, Brian, Laskey, Daniel, Dawodu, Gbalekan, Scheinin, Scott
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649201/
https://www.ncbi.nlm.nih.gov/pubmed/37959256
http://dx.doi.org/10.3390/jcm12216789
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author Housman, Brian
Laskey, Daniel
Dawodu, Gbalekan
Scheinin, Scott
author_facet Housman, Brian
Laskey, Daniel
Dawodu, Gbalekan
Scheinin, Scott
author_sort Housman, Brian
collection PubMed
description Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, the role of single lung transplantation for pulmonary hypertension (PAH) is less clear. The remaining diseased lung will limit clinical improvements and permit downstream sequelae; including residual cough, recurrent infection, and continued pulmonary hypertension. But not every patient can undergo DLT. Advanced age, frailty, co-morbid conditions, and limited availability of organs will all affect surgical candidacy and can offset the benefits of double lung procedures. Studies that compare SLT and DLT do not commonly explore the utility of single lung procedures even though multiple theoretical advantages exist; including reduced waiting times, less waitlist mortality, fewer surgical complications, and lower operative mortality. Worse, multiple forms of publication and selection bias may favor DLT in registry-based studies. In this review, we present the prevailing literature on single and double lung transplants in patients with secondary pulmonary hypertension and clarify the potential utility of these procedures. Materials and Methods: A PubMed search for English-language articles exploring single and double lung transplants in the setting of secondary pulmonary hypertension was conducted from 1990 to 2023. Key words included “single lung transplant”, “double lung transplant”, “pulmonary hypertension”, “rejection”, “complications”, “extracorporeal membranous oxygenation”, “death”, and all appropriate Boolean operators. We prioritized research from retrospective studies that evaluated clinical outcomes from single centers. Conclusions: The question is not whether DLT is better at resolving lung disease; instead, we must ask if SLT is an acceptable form of therapy in a select group of high-risk patients. Further research should focus on how best to identify recipients that may benefit from each type of procedure, and the clinical utility of perioperative VA ECMO.
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spelling pubmed-106492012023-10-27 Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient Housman, Brian Laskey, Daniel Dawodu, Gbalekan Scheinin, Scott J Clin Med Review Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, the role of single lung transplantation for pulmonary hypertension (PAH) is less clear. The remaining diseased lung will limit clinical improvements and permit downstream sequelae; including residual cough, recurrent infection, and continued pulmonary hypertension. But not every patient can undergo DLT. Advanced age, frailty, co-morbid conditions, and limited availability of organs will all affect surgical candidacy and can offset the benefits of double lung procedures. Studies that compare SLT and DLT do not commonly explore the utility of single lung procedures even though multiple theoretical advantages exist; including reduced waiting times, less waitlist mortality, fewer surgical complications, and lower operative mortality. Worse, multiple forms of publication and selection bias may favor DLT in registry-based studies. In this review, we present the prevailing literature on single and double lung transplants in patients with secondary pulmonary hypertension and clarify the potential utility of these procedures. Materials and Methods: A PubMed search for English-language articles exploring single and double lung transplants in the setting of secondary pulmonary hypertension was conducted from 1990 to 2023. Key words included “single lung transplant”, “double lung transplant”, “pulmonary hypertension”, “rejection”, “complications”, “extracorporeal membranous oxygenation”, “death”, and all appropriate Boolean operators. We prioritized research from retrospective studies that evaluated clinical outcomes from single centers. Conclusions: The question is not whether DLT is better at resolving lung disease; instead, we must ask if SLT is an acceptable form of therapy in a select group of high-risk patients. Further research should focus on how best to identify recipients that may benefit from each type of procedure, and the clinical utility of perioperative VA ECMO. MDPI 2023-10-27 /pmc/articles/PMC10649201/ /pubmed/37959256 http://dx.doi.org/10.3390/jcm12216789 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Housman, Brian
Laskey, Daniel
Dawodu, Gbalekan
Scheinin, Scott
Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title_full Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title_fullStr Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title_full_unstemmed Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title_short Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
title_sort single lung transplant for secondary pulmonary hypertension: the right option for the right patient
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649201/
https://www.ncbi.nlm.nih.gov/pubmed/37959256
http://dx.doi.org/10.3390/jcm12216789
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