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Background: End stage lung disease (ESLD) is commonly associated with pulmonary hypertension (PHTN). In a donor restrictive environment, offering patients single over double lung transplants could increase organ utilization. However, there isn't a clinical consensus on how severe PHTN must be to preclude single lung transplant (SLT) due to poor outcomes. We sought to investigate the predictive value of the transpulmonary gradient (TPG) in SLT in patients with ESLD and PHTN. Methods: We performed a retrospective analysis of the United Network for Organ Sharing database and identified all patients who underwent lung transplantation (LT) from May 2005 to March 2021. Patients were stratified based on their TPG score above or below 25 mmHg. Primary outcomes include 1-year survival assessed by generalized linear mixed modeling.Results: Our analysis showed TPG was associated with 1-year survival but this relationship depended on transplant type (P=0.002) with TPG ≥25 being associated with higher mortality in single (P=0.004), but not double LT (P=0.95). This association was maintained when covarying for numerous clinical factors, as well as when excluding deaths within 90 days of LT (P=0.04).Conclusions: A preoperative TPG >25 was associated with decreased 1-year survival in SLT recipients.The use of preoperative TPG combined with other marks of clinical status can help transplant centers in their decision of offering single vs. double lung transplant in patients with ESLD and PHTN.

RATIONALE: Whether short-term glycemic control affects recovery during acute pulmonary exacerbations in CF is unclear. We previously reported that patients with CFRD and better glycemic control have better FEV1 recovery during acute exacerbations. We hypothesized that better glycemic control would be associated with longer time until next exacerbation. METHODS: We used previously abstracted EHR data for all patients with CF ages 6-21 years hospitalized for pulmonary exacerbations at our pediatric CF Center for 2010-2016. Our main outcome was time to the next admission for pulmonary exacerbation. Glycemic control was defined by the area under curve (AUC) from all inpatient meter blood glucoses. Data were analyzed using multiple-event adjusted survival analysis. The basic model was adjusted for age, sex, and FEV1 at admission; the full model additionally included FEV1 recovery until discharge, CFRD status, BMI, presence of gastrostomy tube, F508del genotype, sputum MRSA colonization, and acute prednisone dosing. RESULTS: Poor glycemic control (AUC above the median) was associated with shorter time to next hospitalization in the basic model (HR=1.76 [95%CI=1.02-3.05], p=0.042; see Figure ) and the fully adjusted model (HR=2.05 [1.15-3.66], p=0.016). This was largely driven by patients who completed IV antibiotic treatment at home (HR=3.4 [1.05-10.85], p=0.04). Among patients who completed treatment in the hospital, other characteristics associated with 'survival' time to the next hospitalization included the presence of a gastrostomy tube (HR=4.1 [1.6-10.6], p=0.004), sputum MRSA (HR=2.2 [1.1-4.7], p=0.035), older age at admission (HR=1.1 per each year of age [1.002-1.2], p=0.044) and female sex (HR=1.98 [0.99-4.03], p=0.059). Additionally, among patients who completed treatment at home, receiving acute prednisone was associated with a small but significant protective effect (HR=0.98 [0.95-0.99], p=0.044). CONCLUSIONS: In CF patients hospitalized for a pulmonary exacerbation, poor glycemic control is associated with shorter time to the next hospital admission, independent of admission FEV1, FEV1 improvement during the index admission, CFRD status, or other clinical characteristics. If confirmed in other cohorts, this would further support aiming for normal glycemic levels during CF exacerbations. Patients with poor glycemic control may benefit from completing antibiotic treatment in the hospital.