Pulmonary Hypertension Has Adverse Effect on Post-Lung Transplant Survival

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Although advances have been made in lung transplantation, it continues to have the worst outcomes of any type of organ transplant.
Although advances have been made in lung transplantation, it continues to have the worst outcomes of any type of organ transplant.

Pulmonary hypertension (PH) confirmed by preoperative cardiac catheterization is associated with the prognosis of Asian patients after lung transplantation for end-stage lung disease, according to the results of a study published in the Journal of Thoracic Disease.

Lung transplantation is considered an important option for end-stage lung disease, but the outcomes of this procedure are poorer than for any other type of organ transplantation. Outcomes have improved in recent years as a result of advances in postoperative immunosuppressive therapy, but lung transplantation remains a challenge. Although there is strong evidence indicating that PH is a predictor of disease severity and mortality in patients awaiting lung transplantation, evidence to support the role of PH in the survival of patients postoperatively is limited overall, and is lacking entirely in Asian patients.

Researchers from South Korea reviewed the medical records of 50 patients who had received preoperative right heart catheterization and echocardiography before undergoing single or double lung transplantation between January 2010 and December 2014. They evaluated the relationship between 1-year survival after lung transplantation and preoperative PH.

Overall, 34.0% of the patients died within a year of lung transplantation. The investigators found that the 1-year survival rate of patients with a mean pulmonary arterial pressure (mPAP) ≥25 mm Hg (58.8%) was lower than the survival rate of patients with an mPAP <25 mm Hg (87.5%). A preoperative mPAP of ≥25 mm Hg was associated with a posttransplantation survival hazard ratio of 4.832 (P =.039). In addition, preoperative PH increased the risk for postoperative complications.

Limitations of the study included the small sample size and retrospective design. The authors argued, however, that as ethnicity appears to influence outcomes in patients with end-stage lung disease, and this is the first study conducted in Asian patients, these findings could prove clinically useful.

The authors suggested that in patients with end-stage lung disease, clinicians should consider lung transplantation before mPAP reaches ≥25 mm Hg.

Reference

Kim CY, Park JE, Leem AY, et al. Prognostic value of pre-transplant mean pulmonary arterial pressure in lung transplant recipients: a single-institution experience. J Thorac Dis. 2018;10:1578-1587.

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