Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: A UNOS registry analysis

Vakil, Kairav; Duval, Sue; Sharma, Alok; Adabag, Selçuk; Abidi, Kashan Syed; Taimeh, Ziad; Colvin-Adams, Monica

doi:10.1016/j.ijcard.2014.08.072

Cited by 56 publications

(32 citation statements)

References 19 publications

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“…Unfortunately, there was no reported comparison in terms of short‐term mortality between patients with normal or mildly elevated pre‐transplant PVR < 300 dyn·s·cm −5 and patients with a moderately elevated pre‐transplant PVR ≥ 300 dyn·s·cm −5 . Therefore, the influence of a moderately elevated pre‐transplant PVR on mortality after HTX remains uncertain …”

Section: Discussionmentioning

confidence: 99%

“…A recent large multi-centre study of the United Network for Organ Sharing registry by Vakil et al 27 showed an elevated pre-transplant PVR ≥ 200 dyn·s·cm À5 as a significant predictor of 30 day mortality after HTX. Furthermore, analysis Patients with a native pre-transplant PVR ≥ 300 dyn·s·cm À5 (≥3.75 WU) showed a worse 2 year survival after HTX (P < 0.01) in comparison with patients with a native pre-transplant PVR < 300 dyn·s·cm À5 (<3.75 WU).…”

Section: Mortality and Causes Of Death After Heart Transplantationmentioning

confidence: 99%

“…The influence of an elevated pre-transplant PVR on outcomes after HTX has been evaluated by multiple studies. 4,10-27 However, the association between an elevated PVR and increased mortality after HTX remains indeterminate as some studies reported an increased post-transplant mortality in patients with an elevated pre-transplant PVR, 4,11,13,14,19,22,27 whereas other studies showed no difference. 17,18,[23][24][25][26] Murali et al 15 reported an increased 2 day mortality after HTX in patients with a pre-transplant PVR ≥ 400 dyn·s·cm À5 ; however, no difference in 30 day mortality after HTX was found.…”

Section: Mortality and Causes Of Death After Heart Transplantationmentioning

confidence: 99%

“…Therefore, the influence of a moderately elevated pre-transplant PVR on mortality after HTX remains uncertain. 10,22,27 Chang et al 22 showed in a single-centre study an increased risk of mortality after HTX with each 80 dyn·s·cm À5 increase in pre-transplant PVR. In contrast, Addonizio et al 10 found in another single-centre study no correlation between the degree of an elevated pre-transplant PVR and mortality after HTX.…”

Section: Mortality and Causes Of Death After Heart Transplantationmentioning

confidence: 99%

“…8,9 Several studies have investigated the influence of an elevated pre-transplant PVR on outcomes after HTX. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] However, results regarding post-transplant mortality were inconsistent as studies varied in study design, sample size, follow-up, and definition of an elevated pre-transplant PVR. Thus, the detrimental degree of a moderately increased PVR before HTX on post-transplant results remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

et al. 2020

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Aims Severely elevated pre‐transplant pulmonary vascular resistance (PVR) has been linked to adverse effects after heart transplantation (HTX). The impact of a moderately increased PVR before HTX on post‐transplant outcomes remains uncertain. The aim of this study was to investigate the effects of an elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) on outcomes after HTX. Methods and results This observational retrospective single‐centre study included 561 patients receiving HTX at Heidelberg Heart Center between 1989 and 2015. Patients were stratified by degree of pre‐transplant PVR. Analyses covered demographics, post‐transplant medication, mortality and causes of death after HTX, early post‐transplant atrial fibrillation (AF), and length of the initial hospital stay after HTX. Ninety‐four patients (16.8%) had a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). These patients had a higher rate of early post‐transplant AF [20.2 vs. 10.7%, difference: 9.5%, 95% confidence interval (CI): 0.9–18.1%, P = 0.01] and an increased 30 day post‐transplant mortality (25.5 vs. 6.4%, hazard ratio: 4.4, 95% CI: 2.6–7.6, P < 0.01), along with a higher percentage of death due to transplant failure (21.2 vs. 4.1%, difference: 17.1%, 95% CI: 8.7–25.5%, P < 0.01). Multivariate analysis revealed a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) as a significant risk factor for increased 30 day mortality after HTX (hazard ratio: 4.4, 95% CI: 2.5–7.6, P < 0.01). Kaplan–Meier estimator showed a lower 2 year survival after HTX (P < 0.01) in patients with a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). Conclusions Elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) is associated with early post‐transplant AF and increased mortality after HTX.

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Section: Discussionmentioning

confidence: 99%

Section: Mortality and Causes Of Death After Heart Transplantationmentioning

confidence: 99%