Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: A UNOS registry analysis

Kairav P Vakil, Sue Duval, Alok Sharma, Selcuk Adabag, Syed Abidi, Ziad A Taimeh, Monica Colvin-Adams

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

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.

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.

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.

Original languageEnglish (US)
Pages (from-to)595-599
Number of pages5
JournalInternational Journal of Cardiology
Volume176
Issue number3
DOIs
StatePublished - Oct 20 2014

Bibliographical note

Funding Information:
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C . The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. None of the authors have any financial disclosures or other conflicts of interests to disclose.

Publisher Copyright:
© 2014 Elsevier Ireland Ltd. All rights reserved.

Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.

Keywords

  • Heart transplantation
  • Mortality
  • Pulmonary hypertension

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