Transplantation, bridging, and support technologies in pulmonary hypertension

Area of Science:

• Cardiology
• Pulmonology
• Transplantation Medicine

Background:

• Pulmonary hypertension (PH) management has advanced, yet some patients develop right ventricular dysfunction.
• End-stage PH poses significant challenges, requiring multidisciplinary care and early identification of decompensation risk.

Purpose of the Study:

• To outline the critical role of early transplant assessment in managing advanced PH.
• To highlight the complexities and risks associated with lung transplantation in PH patients.
• To emphasize the importance of specialized centers for comprehensive PH patient care.

Main Methods:

• Review of current treatment paradigms for end-stage PH.
• Analysis of risk assessment factors for lung transplant candidacy in PH.
• Discussion of peri-operative and post-operative management strategies for lung transplantation in PH.
• Evaluation of advancements in mechanical circulatory support and graft allocation.

Main Results:

• Early identification and risk assessment are crucial for transplant eligibility in PH.
• Bilateral lung transplantation is preferred but carries significant risks, including pulmonary edema and graft dysfunction.
• Unpredictable decompensation necessitates rescue therapies and advanced support systems.
• Specialized centers improve outcomes through comprehensive, multidisciplinary care.

Conclusions:

• Optimizing outcomes for PH patients requires a proactive, multidisciplinary approach centered on early transplant evaluation.
• Expert management of lung transplantation and advanced support technologies are vital for critically ill PH patients.
• Specialized centers are indispensable for providing the holistic care needed to improve survival and long-term prognosis in pulmonary hypertension.