[Pulmonary hypertension and lung transplantation]

Area of Science:

• Pulmonary Medicine
• Transplant Surgery

Context:

• Lung transplantation is a definitive treatment for end-stage pulmonary arterial hypertension (PAH).
• Despite advancements in drug therapy, PAH management often necessitates lung transplantation due to disease progression.
• Organ availability and chronic rejection remain significant challenges, highlighting the importance of patient selection.

Purpose:

• To review the current status and criteria for lung transplantation in patients with pulmonary arterial hypertension (PAH).
• To discuss the different types of lung transplant procedures and their indications.
• To emphasize the critical factors influencing transplant success in PAH patients.

Summary:

• Lung transplantation is a viable option for terminal pulmonary arterial hypertension (PAH), offering potential for cardiopulmonary recovery.
• Selection criteria include clinical status (NYHA class III/IV), hemodynamic data (mean PAP > 55 mmHg, CI < 2 L/min/m²), and functional parameters (6-MWT < 332m).
• Bilateral lung transplantation is often preferred, though procedure choice depends on individual patient factors and potential reversibility of right ventricular dysfunction.

Impact:

• Lung transplantation can significantly improve survival and quality of life for patients with advanced PAH.
• Optimizing patient selection and surgical strategy is key to mitigating risks like graft rejection and improving long-term outcomes.
• Further research into donor organ allocation and anti-rejection protocols is essential for expanding the benefits of lung transplantation in PAH.