Comprehensive Risk Assessment in Patients With Pulmonary Arterial Hypertension Referred for Lung Transplantation
BACKGROUND: Whether comprehensive risk assessment predicts post-referral outcome in patients with pulmonary arterial hypertension (PAH) referred for lung transplantation (LT) in Japan is unknown.Methods and Results: We retrospectively analyzed 52 PAH patients referred for LT. Risk status at referral was assessed using 3- and 4-strata models from the 2022 European Society of Cardiology and European Respiratory Society guidelines. The 3-strata model intermediate-risk group was further divided into 2 groups based on the median proportion of low-risk variables (modified risk assessment [MRA]). The primary outcome was post-referral mortality. During follow-up, 9 patients died and 13 patients underwent LT. There was no survival difference among 3-strata model groups. The 4-strata model classified 33, 16, and 3 patients as low intermediate, high intermediate, and high risk, respectively. The 4-strata model identified high-risk patients with a 1-year survival rate of 33%, but did not discriminate survival between the intermediate-risk groups. The MRA classified 15, 28, 8, and 1 patients as low, low intermediate, high intermediate, and high risk, respectively. High intermediate- or high-risk patients had worse survival (P<0.001), with 1- and 3-year survival rates of 64% and 34%, respectively. MRA high intermediate- or high-risk classification was associated with mortality (hazard ratio 12.780; 95% confidence interval 2.583-63.221; P=0.002).
CONCLUSIONS: Patients classified as high intermediate or high risk by the MRA after treatment should be referred for LT.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Circulation journal : official journal of the Japanese Circulation Society - (2024) vom: 23. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ishii, Satoshi [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Revised 25.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1253/circj.CJ-23-0790 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368936562 |
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| 520 | |a BACKGROUND: Whether comprehensive risk assessment predicts post-referral outcome in patients with pulmonary arterial hypertension (PAH) referred for lung transplantation (LT) in Japan is unknown.Methods and Results: We retrospectively analyzed 52 PAH patients referred for LT. Risk status at referral was assessed using 3- and 4-strata models from the 2022 European Society of Cardiology and European Respiratory Society guidelines. The 3-strata model intermediate-risk group was further divided into 2 groups based on the median proportion of low-risk variables (modified risk assessment [MRA]). The primary outcome was post-referral mortality. During follow-up, 9 patients died and 13 patients underwent LT. There was no survival difference among 3-strata model groups. The 4-strata model classified 33, 16, and 3 patients as low intermediate, high intermediate, and high risk, respectively. The 4-strata model identified high-risk patients with a 1-year survival rate of 33%, but did not discriminate survival between the intermediate-risk groups. The MRA classified 15, 28, 8, and 1 patients as low, low intermediate, high intermediate, and high risk, respectively. High intermediate- or high-risk patients had worse survival (P<0.001), with 1- and 3-year survival rates of 64% and 34%, respectively. MRA high intermediate- or high-risk classification was associated with mortality (hazard ratio 12.780; 95% confidence interval 2.583-63.221; P=0.002) | ||
| 520 | |a CONCLUSIONS: Patients classified as high intermediate or high risk by the MRA after treatment should be referred for LT | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Prognostic prediction | |
| 650 | 4 | |a Referral | |
| 650 | 4 | |a Transplant system | |
| 700 | 1 | |a Hatano, Masaru |e verfasserin |4 aut | |
| 700 | 1 | |a Minatsuki, Shun |e verfasserin |4 aut | |
| 700 | 1 | |a Hirose, Kazutoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Saito, Akihito |e verfasserin |4 aut | |
| 700 | 1 | |a Yagi, Hiroki |e verfasserin |4 aut | |
| 700 | 1 | |a Shimbo, Mai |e verfasserin |4 aut | |
| 700 | 1 | |a Soma, Katsura |e verfasserin |4 aut | |
| 700 | 1 | |a Konoeda, Chihiro |e verfasserin |4 aut | |
| 700 | 1 | |a Sato, Masaaki |e verfasserin |4 aut | |
| 700 | 1 | |a Nakajima, Jun |e verfasserin |4 aut | |
| 700 | 1 | |a Komuro, Issei |e verfasserin |4 aut | |
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