Pulmonary Hypertension Unrelated to Early Lung Transplant Mortality in ILD

Although intrahospital mortality does not differ between patients with and without pulmonary hypertension (PH) who undergo lung transplantation because of interstitial lung disease (ILD), the postoperative length of hospital stay is greater in patients with PH and ILD. A retrospective cohort study was conducted at the 12 de Octubre University Hospital in Madrid, Spain, with the results published in Transplantation Proceedings.

Recognizing that PH is a comorbidity associated with ILD, the investigators sought to assess the influence of PH on intrahospital mortality in patients undergoing lung transplantation for ILD. Data from a total of 66 patients with ILD who underwent lung transplantation at the hospital between October 2008 and June 2014 were evaluated. In this study, PH was defined as mean pulmonary arterial pressure of ≥25 mm Hg as reported by right-sided heart catheterization. Intrahospital mortality was defined as any death that occurred posttransplantation in patients who had not been discharged from the hospital.

All participants were stratified by the presence or absence of PH prior to lung transplantation. Overall, 41% (27 of 66) of the patients had PH. Those participants in the PH group had a lower diffusing capacity of carbon monoxide, carbon monoxide transfer coefficient, and 6-minute walk test score, along with a higher total lung capacity, modified medical research council dyspnea scale, and lung allocation scale score compared with participants in the non-PH group. Furthermore, patients with PH more often underwent double lung transplant (59.3%) rather than single lung transplant (40.7%).

Intrahospital mortality occurred in 9 of the 66 participants. No significant differences were observed on Kaplan-Meier survival curves in the PH and non-PH arms, with a median survival time of 46 days vs 33 days, respectively (P =.056). The postoperative length of stay in the hospital, however, was significantly greater in the PH group compared with the non-PH group (30 days vs 24 days, respectively; P =.03).

The small sample size and retrospective design were major limitations of the study. In addition, ILD can represent a heterogeneous group of diseases with varying prognoses. The investigators concluded that a larger multicenter study is warranted to further confirm the results of their analysis.

Reference

Corral-Blanco M, Prudencio-Ribera VC, Jarrín-Estupiñán ME, et al. Influence of pulmonary hypertension on intrahospital mortality in lung transplantation for interstitial lung disease. Transplant Proc. 2019;51(2):380-382.