Hipertensión pulmonar en pacientes con fibrosis pulmonar y sobrevida post-trasplante pulmonar

Abstract

Pulmonary hypertension in patients with pulmonary fibrosis and survival after lung transplant Introduction: The presence of pulmonary hypertension (PH) in patients with pulmonary fibrosis is a predictor of severity and poor survival in patients awaiting lung transplantation. Little is known about the impact of PH on survival after lung transplantation. Objective: To evaluate the effect of PH in pulmonary fibrosis patient survival after lung transplantation. Methods: Retrospective study of patients diagnosed with pulmonary fibrosis subjected to lung transplantation at the Instituto Nacional del Tórax during the period of August 2010 to June 2015. Thresholds of ≥ 25 and ≥ 35 mm Hg were chosen for mean pulmonary artery pressure (PAmean) and systolic pulmonary artery pressure (PAsystolic), respectively, as indicators of PH. Results: Out of a total of 63 patients undergoing lung transplantation during the 2010-2015 period, 42 patients were diagnosed with pulmonary fibrosis. 35 of these patients had histologic diagnosis of usual interstitial pneumonia (UIP) and 7 of extrinsic allergic alveolitis in fibrotic stage. Of the total 25 patients with pulmonary fibrosis (60%) had PH in the pre-transplant period. A total of 15 patients died during the follow-up. There was no significant difference in survival between patients with and without PH (p = 0.74). Conclusions: Similar to international studies, we observed that the presence of PH in patients with pulmonary fibrosis did not increase risk of death in post-transplant period.

Comorbidities of Patients With Idiopathic Pulmonary Fibrosis in Four Latin American Countries. Are There Differences by Country and Altitude?

“…The mechanism of hypoxic vasoconstriction with a secondary increase in pulmonary vascular resistance triggered by lower PAO 2 values at altitude, the pulmonary artery remodeling described in long-term exposure to hypoxia and the erythrocytosis described in altitude in healthy subjects and in patients with respiratory disease ( 10 , 26 ), could explain the development of PH in these patients ( 14 , 15 ). Along the same lines of our data, in previous studies in Mexico City and Bogotá, high prevalence of PH have been described in patients with chronic respiratory disease ( 27 , 28 ).…”