Pulmonary hypertension before first and second lung transplantation

Area of Science:

• Cardiology
• Pulmonology
• Transplant Surgery

Background:

• Pulmonary hypertension (PH) is common in advanced lung disease patients undergoing lung transplantation.
• PH is frequently observed before both initial and second lung transplants.
• The prognostic significance of PH in lung transplant recipients needs further investigation.

Purpose of the Study:

• To determine the relationship between pulmonary hemodynamics before first and second lung transplantation.
• To assess the prognostic implications of PH in patients undergoing a second lung transplant.

Main Methods:

• Retrospective analysis of adult patients (≥16 years) undergoing lung re-transplantation between 1997 and 2009.
• Right heart catheterization data obtained before both first and second lung transplantation were analyzed.
• Correlation between pre-transplant hemodynamics and post-transplant outcomes, including survival and bronchiolitis obliterans syndrome (BOS), was assessed.

Main Results:

• Eighteen patients were included; bronchiolitis obliterans syndrome (BOS) was the sole indication for re-transplantation.
• PH prevalence was 39% before the first transplant and 56% before the second (p=0.91).
• No pre-transplant hemodynamic variables predicted PH before re-transplantation; PH before re-transplantation did not predict survival or BOS development.

Conclusions:

• Pre-transplant PH does not predict the development of PH before a second lung transplant.
• PH identified before re-transplantation did not demonstrate prognostic value for outcomes after the second lung transplant in this cohort.