Lung transplantation for pulmonary hypertension

Abstract

Lung transplantation is an accepted therapeutic intervention for patients with pulmonary arterial hypertension (PAH) who fail medical therapy. Highly selected candidates with PAH may enjoy improved survival by combining medical therapy with transplantation. Despite the known benefits of lung transplantation that include improvement in haemodynamics, exercise tolerance, shortness of breath and long-term survival, this intervention is associated with significant shortcomings. These include, the need for lifelong immunosuppression, and the morbidity associated with the increased risk for infection and allograft rejection. To maximise the potential outcomes of lung transplantation, candidates should be selected based on the international guidelines developed by a consensus panel of experts in the field (J Heart Lung Transplant, 25, 2006, 745). Early referral to a centre with expertise in the management of PAH and transplantation increases the chances of achieving the best possible long-term outcome for patients with this devastating disease.

Pulmonary Arterial Hypertension and Lung Transplantation

“…Most experts believe pulmonary vascular disease at the time of LT (IPAH or secondary PAH) to be a risk factor for PGD. 134 Animal studies using SLT in rats for chemical-induced PAH demonstrate a preferential flow of blood to the allograft that was fatal in cases of severe preoperative PAH, presumably because of PGD-related complications. 135,136 A retrospective review in humans comparing SLT for PAH versus emphysema confirmed significantly increased allograft blood flow in the PAH patients.…”

New targets for pulmonary hypertension: gene and stem cell therapy

“…When disease progresses on maximal therapy, lung transplantation, for those who qualify, remains a viable option. Orens (19) in this edition describes its crucial role for advanced PH. The issues of specialised care for these complex patients are addressed by Housten‐Harris (20).…”