Pulmonary hypertension as a risk factor of mortality after lung transplantation

TY - JOUR

T1 - Pulmonary hypertension as a risk factor of mortality after lung transplantation

AU - Andersen, Kasper H

AU - Schultz, Hans Henrik L

AU - Nyholm, Benjamin

AU - Iversen, Martin P

AU - Gustafsson, Finn

AU - Carlsen, Jørn

N1 - © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Purpose: Pulmonary hypertension (PH) is recognized as a risk factor in lung transplantation as reflected in the lung allocation score (LAS). We examined the impact of PH on outcome after lung transplantation, with special emphasis on pre- and post-capillary PH. Methods: Consecutive lung transplant recipients were evaluated according to ISHLT criteria including right heart catheterization in the period from 1992 to October 2014. Post-transplant survival was assessed according to hemodynamic characteristics: post-capillary PH (mean pulmonary arterial pressure [mPAP] ≥ 25 mmHg and pulmonary arterial wedge pressure [PAWP] > 15 mmHg), pre-capillary PH (mPAP ≥ 25 mmHg, PAWP ≤ 15 mmHg) and non-PH (mPAP < 25 mmHg). Results: Of 518 transplant recipients, 58 (11%) had post-capillary PH. Pre-capillary PH was present in 211 (41%) and 249 (48%) non-PH. Post-capillary PH and pre-capillary PH were associated with worse 90-d outcomes after transplantation compared to non-PH (p = 0.043 and 0.003, respectively). The negative effect persisted 1 yr post-transplantation in pre-capillary PH (p = 0.037), but not in post-capillary PH (p = 0.447). Long-term survival was unaffected by hemodynamic classification. Conclusion: Post-capillary PH was present in 11% and pre-capillary PH in 41% of the transplant cohort. Post-capillary PH and pre-capillary PH were associated with inferior 90-d survival, but long-term survival was unaffected.

AB - Purpose: Pulmonary hypertension (PH) is recognized as a risk factor in lung transplantation as reflected in the lung allocation score (LAS). We examined the impact of PH on outcome after lung transplantation, with special emphasis on pre- and post-capillary PH. Methods: Consecutive lung transplant recipients were evaluated according to ISHLT criteria including right heart catheterization in the period from 1992 to October 2014. Post-transplant survival was assessed according to hemodynamic characteristics: post-capillary PH (mean pulmonary arterial pressure [mPAP] ≥ 25 mmHg and pulmonary arterial wedge pressure [PAWP] > 15 mmHg), pre-capillary PH (mPAP ≥ 25 mmHg, PAWP ≤ 15 mmHg) and non-PH (mPAP < 25 mmHg). Results: Of 518 transplant recipients, 58 (11%) had post-capillary PH. Pre-capillary PH was present in 211 (41%) and 249 (48%) non-PH. Post-capillary PH and pre-capillary PH were associated with worse 90-d outcomes after transplantation compared to non-PH (p = 0.043 and 0.003, respectively). The negative effect persisted 1 yr post-transplantation in pre-capillary PH (p = 0.037), but not in post-capillary PH (p = 0.447). Long-term survival was unaffected by hemodynamic classification. Conclusion: Post-capillary PH was present in 11% and pre-capillary PH in 41% of the transplant cohort. Post-capillary PH and pre-capillary PH were associated with inferior 90-d survival, but long-term survival was unaffected.

KW - Cardiac Catheterization

KW - Female

KW - Follow-Up Studies

KW - Glomerular Filtration Rate

KW - Graft Rejection

KW - Graft Survival

KW - Hemodynamics

KW - Humans

KW - Hypertension, Pulmonary

KW - Lung Diseases

KW - Lung Transplantation

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Prognosis

KW - Respiratory Function Tests

KW - Retrospective Studies

KW - Risk Factors

KW - Survival Rate

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/ctr.12692

DO - 10.1111/ctr.12692

M3 - Journal article

C2 - 26782019

SN - 0902-0063

VL - 30

SP - 357

EP - 364

JO - Clinical Transplantation

JF - Clinical Transplantation

IS - 4

ER -