Heart Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Heart Transplant, including details on risks, prognosis, procedure, surgery, organ donation.

Pre-existing pulmonary hypertension in patients with end-stage heart failure: impact on clinical outcome and hemodynamic follow-up after orthotopic heart transplantation.

Goland S, Czer LS, Kass RM, De Robertis MA, Mirocha J, Coleman B, Capelli C, Raissi S, Cheng W, Fontana G, Trento A

Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.

BACKGROUND: The purpose of this investigation was to determine the influence of pre-existing pulmonary hypertension (PHT) on outcome and to assess the pulmonary hemodynamic changes after heart transplantation (HT). METHODS: A total of 410 patients were studied before and after (1 month and 1 year) HT: Group 1 (n = 266) had no PHT (PVR < 3 Wood units [WU], TPG < 10 mm Hg); Group 2 (n = 112) had mild-moderate PHT (PVR 3 to 6 WU, TPG 10 to 20 mm Hg); and Group 3 (n = 32) had severe PHT (PVR > 6 WU, TPG > 20 mm Hg). RESULTS: Mean (+/- SD) follow-up was 5.2 +/- 4.1 years, mean recipient age was 57 +/- 11, and mean donor age was 30 +/- 12 years. Baseline characteristics were similar in all groups, except donor/recipient weight ratio, which was higher in patients with PHT (p = 0.002). There was a significant (p < 0.0001) decrease in mean TPG to 11.0 within the first month and to 9.5 mm Hg after the first year. Decreases in PVR to 2.2 and 2.0 WU at 1 month and 1 year, respectively (p < 0.0001 for both) were also found. Reversibility (after vasodilation) of PHT was obtained in 85% of patients in Group 2 and in 84% in Group 3. Patients' PHT did not show a significant difference in 30-day mortality (p = 0.9) and long-term survival (p = 0.8). Patients with residual post-transplant PHT (PVR > or = 3 WU) had reduced long-term survival (p = 0.03). Multivariate analysis showed no evidence that elevated PVR was associated with death. CONCLUSIONS: Pre-existing elevated PVR that responds to vasodilator challenge does not have a negative influence on short- and long-term survival after HT. We found that residual post-transplant PHT is associated with decreased long-term survival.

Published 3 April 2007 in J Heart Lung Transplant, 26(4): 312-8.
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