Impact of postoperative pulmonary hypertension on outcome after heart transplantation

We wanted to investigate the effects of postoperative pulmonary hypertension (PH_postop: mean pulmonary artery pressure [MPAP] ≥ 25 mmHg), diastolic pressure gradient (DPG), pulmonary vascular resistance (PVR), and repeated hemodynamic measurements on long-term survival after heart transplantation (HT).

Eighty-nine patients who underwent HT at Skåne University Hospital in Lund in the period 1988-2010 and who were evaluated with right-heart-catheterization at rest, prior to HT and repeatedly during the first postoperative year, were grouped based on their MPAP, DPG, and PVR.

One year after HT, survival was lower in patients with PH_postop than in those without, in patients with DPG ≥7 mmHg than in those with DPG <7 mmHg, and in patients with PVR >3 WU than in those with PVR ≤3 WU. Moreover, compared to patients with no PH_postop or with PH_postop at one evaluation during the first year after HT, PH_postop at repeated evaluations was associated with higher mortality (hazard ratio 3.4, 95% CI 1.4-8.0). There was no significant difference in acute cellular rejection between patients with and without PH_postop, but postoperative kidney function was worse in patients with repeated PH_postop.

When defined according to present guidelines, PH one year after HT may emerge as a prognostic marker for long-term outcome after HT. Moreover, PH_postop at repeated evaluations during the first year after HT had stronger prognostic value than PH_postop at a single examination, illustrating a means of identifying a high-risk population. However, confirmation in larger multi-center studies is warranted.