Kairav Vakil1, Sue Duval2, Alok Sharma2, Selcuk Adabag3, Kashan Syed Abidi2, Ziad Taimeh2, Monica Colvin-Adams2. 1. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: vakil012@umn.edu. 2. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. 3. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota and Veterans Affairs Medical Center, Minneapolis, MN, USA.
Abstract
INTRODUCTION: Severe pre-transplant pulmonary hypertension (PH) has been associated with adverse short-term clinical outcomes after heart transplantation in relatively small single-center studies. The impact of pre-transplant PH on long-term survival after heart transplantation has not been examined in a large, multi-center cohort. METHODS: Adults (≥18 years) who underwent first time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing registry. Pre-transplant PH was classified as mild, moderate, or severe based on pulmonary vascular resistance (PVR), trans-pulmonary gradient (TPG), and pulmonary artery (PA) mean pressure. Primary outcome was all-cause mortality. RESULTS: Data from 26,649 heart transplant recipients (mean age 52±12 years; 76% male; 76% Caucasian) were analyzed. During a mean follow-up of 5.7±4.8 years, there were 10,334 (39%) deaths. Pre-transplant PH (PVR≥2.5 WU) was a significant predictor of mortality (hazard ratio 1.10, 95% confidence interval 1.05-1.14, p<0.0001) in multivariable analysis. However, the severity of pre-transplant PH (mild/moderate vs. severe) did not affect short or long-term survival. Similarly, even in patients who were supported with either a left ventricular assist device or a total artificial heart prior to transplant, severe pre-transplant PH was not associated with worse survival when compared to patients with mild/moderate pre-transplant PH. CONCLUSION: Pre-transplant PH (PVR≥2.5 WU) is associated with a modest increase in mortality when compared to patients without pre-transplant PH. However, the severity of pre-transplant PH, assessed by PVR, TPG, or mean PA pressure, is not a discriminating factor for poor survival in patients listed for heart transplantation.
INTRODUCTION: Severe pre-transplant pulmonary hypertension (PH) has been associated with adverse short-term clinical outcomes after heart transplantation in relatively small single-center studies. The impact of pre-transplant PH on long-term survival after heart transplantation has not been examined in a large, multi-center cohort. METHODS: Adults (≥18 years) who underwent first time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing registry. Pre-transplant PH was classified as mild, moderate, or severe based on pulmonary vascular resistance (PVR), trans-pulmonary gradient (TPG), and pulmonary artery (PA) mean pressure. Primary outcome was all-cause mortality. RESULTS: Data from 26,649 heart transplant recipients (mean age 52±12 years; 76% male; 76% Caucasian) were analyzed. During a mean follow-up of 5.7±4.8 years, there were 10,334 (39%) deaths. Pre-transplant PH (PVR≥2.5 WU) was a significant predictor of mortality (hazard ratio 1.10, 95% confidence interval 1.05-1.14, p<0.0001) in multivariable analysis. However, the severity of pre-transplant PH (mild/moderate vs. severe) did not affect short or long-term survival. Similarly, even in patients who were supported with either a left ventricular assist device or a total artificial heart prior to transplant, severe pre-transplant PH was not associated with worse survival when compared to patients with mild/moderate pre-transplant PH. CONCLUSION: Pre-transplant PH (PVR≥2.5 WU) is associated with a modest increase in mortality when compared to patients without pre-transplant PH. However, the severity of pre-transplant PH, assessed by PVR, TPG, or mean PA pressure, is not a discriminating factor for poor survival in patients listed for heart transplantation.
Authors: Yan Ru Su; Manuel Chiusa; Evan Brittain; Anna R Hemnes; Tarek S Absi; Chee Chew Lim; Thomas G Di Salvo Journal: Pulm Circ Date: 2015-09 Impact factor: 3.017
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Authors: Rasmus Rivinius; Matthias Helmschrott; Arjang Ruhparwar; Bastian Schmack; Fabrice F Darche; Dierk Thomas; Tom Bruckner; Andreas O Doesch; Hugo A Katus; Philipp Ehlermann Journal: ESC Heart Fail Date: 2020-02
Authors: Ioannis Mastoris; Joseph E Tonna; Jinxiang Hu; Andrew J Sauer; Nicholas A Haglund; Peter Rycus; Yu Wang; William J Wallisch; Travis O Abicht; Matthew R Danter; Ryan J Tedford; James C Fang; Zubair Shah Journal: Circ Heart Fail Date: 2021-12-09 Impact factor: 8.790