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| |  CHEST: Medical Therapy Beats Lung Transplantation In Management Of Primary Pulmonary Hypertension By Alison Palkhivala Special to DG News SAN DIEGO, CA -- November 5, 2002 -- Patients with primary pulmonary hypertension appear to survive longer if managed with medical therapy rather than with lung transplantation. These findings call into question the notion that medical therapy should only serve as a bridge to lung transplantation among this patient population. Angela C. Hospenthal, MD, and colleagues from the departments of pulmonary and critical care medicine and cardiothoracic surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States, explored outcomes of patients with primary pulmonary hypertension treated with medical therapy versus lung transplantation. Dr. Hospenthal presented the findings here this week at the annual meeting of the American College of Chest Physicians (CHEST). As part of a retrospective study, the investigators reviewed the management of primary pulmonary hypertension at two academic institutions between 1985 and 2002. They identified seven patients treated with lung transplantation and eight treated with medical therapy. Seven patients on medical therapy were treated with epoprostenol, and one was treated with bosentan. Two of the patients crossed over from medical therapy to lung transplantation because of worsening functional status. All of these patients had documented elevated pulmonary artery systolic pressures on cardiac catheterization and no sign of a secondary cause of pulmonary hypertension, with the exception of scleroderma. Lung transplantation resulted in better improvement in pulmonary artery systolic pressure than medical therapy, but survival rates were higher in patients who underwent medical therapy. In fact, none of the patients who underwent lung transplantation are still alive, while four of the eight treated with medical therapy are still alive. The average survival time for patients who underwent lung transplantation was 1.9 years. The average time to the present, death or crossover to lung transplantation for those on medical therapy was 2.7 years. One of the patients who crossed over from medical therapy to transplantation is still alive; she underwent transplant surgery just over six months ago. "Our findings support the current practice of starting medical therapy for initial management of primary pulmonary hypertension," said Dr. Hospenthal, "reserving lung transplantation, specifically bilateral lung transplantation, for those without significant clinical improvement on medication."
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