Predictors of early mortality after lung transplantation for idiopathic pulmonary arterial hypertension

Abstract

Lung transplantation remains an important therapeutic option for idiopathic pulmonary arterial hypertension (IPAH), yet short‐term survival is the poorest among the major diagnostic categories. We sought to develop a prediction model for 90‐day mortality using the United Network for Organ Sharing database for adults with IPAH transplanted between 2005 and 2021. Variables with a p value ≤ 0.1 on univariate testing were included in multivariable analysis to derive the best subset model. The cohort comprised 693 subjects, of whom 71 died (10.2%) within 90 days of transplant. Significant independent predictors of early mortality were: extracorporeal circulatory support and/or mechanical ventilation at transplant (OR: 3; CI: 1.4–5), pulmonary artery diastolic pressure (OR: 1.3 per 10 mmHg; CI: 1.07–1.56), forced expiratory volume in the first second percent predicted (OR: 0.8 per 10%; CI: 0.7–0.94), recipient total bilirubin >2 mg/dL (OR: 3; CI: 1.4–7.2) and ischemic time >6 h (OR: 1.7, CI: 1.01–2.86). The predictive model was able to distinguish 25% of the cohort with a mortality of ≥20% from 49% with a mortality of ≤5%. We conclude that recipient variables associated with increasing severity of pulmonary vascular disease, including pretransplant advanced life support, and prolonged ischemic time are important risk factors for 90‐day mortality after lung transplant for IPAH.