Pulmonary Hypertension and Lung Transplantation.

Area of Science:

• Cardiology
• Pulmonology
• Transplantation Medicine

Background:

• Pulmonary artery hypertension (PAH) is a severe end-stage lung disease.
• Lung transplantation is a gold standard treatment for PAH.
• Transplant strategies for PAH have evolved over the past two decades.

Purpose of the Study:

• To review current literature on lung transplantation for PAH.
• To focus on risk stratification, donor allocation, bridging strategies, and perioperative management.
• To discuss advancements in adult and pediatric PAH lung transplantation.

Main Methods:

• Literature review of recent advancements in PAH lung transplantation.
• Analysis of shifts in transplant indications and strategies.
• Evaluation of the role of antihypertensive drugs and extracorporeal membrane oxygenation (ECMO).

Main Results:

• Antihypertensive drugs delay transplantation, reserving it for high-risk patients.
• Extracorporeal membrane oxygenation (ECMO) facilitates cardiac remodeling post-transplantation.
• Shift from heart-lung to bilateral lung transplantation increases organ availability.

Conclusions:

• ECMO-bridging is vital for selected PAH patients but carries risks.
• Improved organ allocation for high-risk PAH patients can reduce ECMO use and enhance outcomes.
• Bilateral lung transplantation is increasingly favored over combined heart-lung transplantation for PAH.