A Congestive Hemodynamic Footprint Is Associated With Worse Clinical Outcomes in Lung Transplant Recipients

Right heart catheterization (RHC) and echocardiography are integral in the assessment of pulmonary hypertension (PH) and cardiac function for lung transplant (LT) candidates. However, the impact of these metrics on post-LT outcomes remains unclear. We performed a single-center retrospective study of adult LT recipients from 2010 to 2022 to evaluate how RHC and echocardiographic variables relate to mortality, length of stay (LOS), duration of mechanical ventilation (MV), and rejection. An unsupervised cluster analysis was used to identify hemodynamic subgroups with adverse outcomes. Among 297 patients undergoing single or bilateral LT, most had interstitial lung disease (ILD; 52%), followed by chronic obstructive pulmonary disease (COPD; 32%) and other diagnoses (16%); mortality did not differ by indication (COPD 51%, ILD 37%, other 45%; p = 0.10), by PH defined as mean pulmonary artery pressure (mPAP) > 20 mmHg or pulmonary vascular resistance (PVR) ≥ 2 Woods Units (p = 0.45 for each), or by PH classification (isolated post-capillary, combined pre/post-capillary, or no PH; p = 0.77). However, in COPD, a higher mPAP, right ventricular (RV) filling pressures, and echocardiographic indices of diastolic function and RV pressure overload were associated with greater mortality. Across the cohort, PH was associated with longer LOS, more MV days, and higher rejection rates. Unsupervised cluster analysis identified a subgroup with elevated biventricular filling pressures and RV dysfunction consistent with a congestive hemodynamic footprint that had worse event-free post-LT survival (p = 0.049). These findings highlight the value of integrated invasive and noninvasive hemodynamics beyond the assessment of PH in LT recipients.