Background:
Conflicting data exist regarding the impact of reversible pulmonary hypertension (PHTN) on post-transplant outcomes. We sought to determine how reversible PHTN affects survival in a large cohort of heart transplant recipients.
Methods:
A retrospective cohort study of United Network for Organ Sharing (UNOS) data from January 1, 2000 to December 31, 2006 was performed. Based on the amount of pulmonary vascular resistance (PVR) at initial listing and the most recent PVR prior to transplant, patients were stratified into 3 groups (Normal -PVR always < 2.5 Wood units, Reversible - PVR initially > 2.5, but < 2.5 prior to transplant, Fixed - PVR always > 2.5) and survival post transplant was analyzed.
Results:
Data was available on 10331 recipients. Of those patients, 3886 (37.6%) patients were classified as Normal, 1621 (15.7%) were Reversible, and 4824 (46.7%) had Fixed PHTN. Among the fixed group, PHTN was severe in 1989 patients (PVR >=5). Kaplan-Meier survival was comparable by log rank test between the normal and reversible groups (p>0.05) but was significantly worse for the fixed group (p<0.001). Sub-analysis of patients with initial PVR>=5 in the reversible group also had comparable survival to the normal group. These survival results were confirmed in a propensity-adjusted multivariate Cox regression analysis, controlling for clinically relevant co-founders. Furthermore, similar results were obtained using PVR of 2.5 or 5 as the cut-off points.
Conclusions:
The UNOS database has provided the largest number of patients analyzed by PVR. Reversible pulmonary hypertension has comparable post-transplant survival regardless of initial severity.
Baseline pulmonary hypertension in heart transplant recipients: 9 years of experience at Almazov National Medical Research Centre
