Prognostic value of pre-transplant mean pulmonary arterial pressure in lung transplant recipients: a single-institution experience

Kim, Chi Young; Park, Ji Eun; Leem, Ah Young; Song, Joo Han; Kim, Song Yee; Chung, Kyung Soo; Kim, Eun Young; Jung, Ji Ye; Kang, Young Ae; Kim, Young Sam; Chang, Joon; Lee, Jin Gu; Paik, Hyo Chae; Park, Moo Suk

doi:10.21037/jtd.2018.03.46

Cited by 8 publications

(7 citation statements)

References 41 publications

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“…In patients with IPF and idiopathic fibrotic NSIP, co‐existing PH has been found to be associated with significantly worse overall and transplant‐free survival 14,17,22 . Relatedly, others have investigated the impact of pretransplantation PH on posttransplantation outcomes in patients with chronic lung disease and reached conflicting conclusions 12,23,24 . In our analysis, the presence of precapillary PH in patients with CRLD before lung transplant did not significantly affect waitlist mortality or posttransplant survival.…”

Section: Discussionmentioning

confidence: 51%

Prevalence of pulmonary hypertension in patients with COVID‐19 related lung disease listed for lung transplantation: A UNOS registry analysis

et al. 2023

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COVID‐19 related lung disease (CRLD) has emerged as an indication for lung transplantation (LT) in highly select patients. The prevalence and prognostic implication of coexisting pulmonary hypertension (PH) in patients with CRLD listed for LT is not known. Adult patients in the United Network for Organ Sharing database listed for LT for COVID‐19 related acute respiratory distress syndrome or fibrosis through March 2022 were identified. The prevalence and impact of precapillary PH on pre‐ and posttransplantation survival was determined. Time‐to‐event analysis was used to compare outcomes between those with and without precapillary PH. We identified 245 patients listed for LT for CRLD who had right heart catheterization data available at the time of registry listing. Median age of the cohort was 54 years (interquartile range [IQR]: 46, 60), 56 (22.9%) were female, and the median lung allocation score was 81.3 (IQR: 53.3, 89.4). The prevalence of precapillary PH at the time of transplant listing was 27.9%. There was no significant difference in pretransplant mortality in patients with and without precapillary PH (sHR: 0.5; 95% confidence interval [CI]: 0.1–1.7, p = 0.261). A total of 187 patients ultimately underwent LT; of those, 60 (31.0%) were identified as having precapillary PH during the waitlist period. Posttransplantation survival was similar between patients with and without pretransplant precapillary PH (hazard ratio: 0.96; 95% CI: 0.2–3.7, p = 0.953). We observed a high rate of concomitant precapillary PH in patients listed for LT for CRLD. Though common, coexisting precapillary PH was not associated with a significant difference in either pre‐ or post‐transplantation outcomes.

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Section: Discussionmentioning

confidence: 51%

Prevalence of pulmonary hypertension in patients with COVID‐19 related lung disease listed for lung transplantation: A UNOS registry analysis

et al. 2023

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“…It was the most frequent comorbidity found in half of our cohort. Right heart failure and especially its approximative surrogate of pulmonary hypertension >25 mmHg were also risk factors for mortality in a single center study ( 14 ) and in the United Network for Organ Sharing (UNOS) Database in 3105 emphysema patients ( 15 ). Even though right heart failure may be partially to fully reversible after lung transplantation, pulmonary hypertension requires sometimes peri-operative extracorporeal membrane oxygenation (ECMO) implantation to avoid reperfusion edema which goes along with a variety of factors that can increase morbidity ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Ehrsam¹,

Schuurmans²,

Laager³

et al. 2022

Transpl Int

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Since candidates with comorbidities are increasingly referred for lung transplantation, knowledge about comorbidities and their cumulative effect on outcomes is scarce. We retrospectively collected pretransplant comorbidities of all 513 adult recipients transplanted at our center between 1992–2019. Multiple logistic- and Cox regression models, adjusted for donor-, pre- and peri-operative variables, were used to detect independent risk factors for primary graft dysfunction grade-3 at 72 h (PGD3-T72), onset of chronic allograft dysfunction grade-3 (CLAD-3) and survival. An increasing comorbidity burden measured by Charleston-Deyo-Index was a multivariable risk for survival and PGD3-T72, but not for CLAD-3. Among comorbidities, congestive right heart failure or a mean pulmonary artery pressure >25 mmHg were independent risk factors for PGD3-T72 and survival, and a borderline risk for CLAD-3. Left heart failure, chronic atrial fibrillation, arterial hypertension, moderate liver disease, peptic ulcer disease, gastroesophageal reflux, diabetes with end organ damage, moderate to severe renal disease, osteoporosis, and diverticulosis were also independent risk factors for survival. For PGD3-T72, a BMI>30 kg/m2 was an additional independent risk. Epilepsy and a smoking history of the recipient of >20packyears are additional independent risk factors for CLAD-3. The comorbidity profile should therefore be closely considered for further clinical decision making in candidate selection.

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“…(14) Pulmonary hypertension is one of the eligibility criteria for inclusion in transplant lists, (7) and may impact the selection of anesthetic procedures (use of extracorporeal circulation or intraoperative extracorporeal membrane oxygenation) as well as post-transplant survival. (18)(19)(20) Individual mPAP and PCP values may be used as transplant prioritization criteria in countries adopting the lung allocation score (LAS). (21) Therefore, these patients are often submitted to right heart catheterization.…”

Section: ❚ Discussionmentioning

confidence: 99%

Accuracy of echocardiography and chest tomography for pulmonary hypertension screening in patients awaiting lung transplantation

Degani-Costa

Assis

Gonçalves

et al. 2021

Einstein (São Paulo)

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Objective: To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation. Methods: A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists. Results: This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%. Conclusion: Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness.

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Prognostic value of pre-transplant mean pulmonary arterial pressure in lung transplant recipients: a single-institution experience

Abstract: Confirmation of PH via preoperative cardiac catheterization was associated with the prognosis of the patient after LTX. Clinicians should consider the necessity for early transplantation surgery before the mPAP reaches ≥25 mmHg.

Cited by 8 publications

References 41 publications

Prevalence of pulmonary hypertension in patients with COVID‐19 related lung disease listed for lung transplantation: A UNOS registry analysis

Prevalence of pulmonary hypertension in patients with COVID‐19 related lung disease listed for lung transplantation: A UNOS registry analysis

Recipient Comorbidities for Prediction of Primary Graft Dysfunction, Chronic Allograft Dysfunction and Survival After Lung Transplantation

Accuracy of echocardiography and chest tomography for pulmonary hypertension screening in patients awaiting lung transplantation

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