Adverse outcomes associated with pulmonary hypertension in chronic obstructive pulmonary disease after bilateral lung transplantation

Don Hayes Jr; Dmitry Tumin; Maria M Budev; Joseph D Tobias; Roy C St John; Jasleen Kukreja

doi:10.1016/j.rmed.2017.04.010

Adverse outcomes associated with pulmonary hypertension in chronic obstructive pulmonary disease after bilateral lung transplantation

Respir Med. 2017 Jul:128:102-108. doi: 10.1016/j.rmed.2017.04.010. Epub 2017 Apr 22.

Authors

Don Hayes Jr¹, Dmitry Tumin², Maria M Budev³, Joseph D Tobias⁴, Roy C St John⁵, Jasleen Kukreja⁶

Affiliations

¹ Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: hayes.705@osu.edu.
² Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
³ Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁴ Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
⁵ Mount Carmel Health, Columbus, OH, USA.
⁶ Department of Surgery, University of California at San Francisco Medical Center, San Francisco, CA, USA.

PMID: 28476472
DOI: 10.1016/j.rmed.2017.04.010

Abstract

Background: The impact of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) on survival after lung transplantation (LTx) is not known.

Material and methods: First-time adult LTx recipients with COPD transplanted between May 2005 and September 2013 were identified in the United Network for Organ Sharing Registry database, and tracked from transplant date until death or censoring. Right heart catheterization (RHC) measurements at time of wait listing were used to predict all-cause mortality after LTx, with multivariable analyses stratified by transplant type.

Results: Of 3362 COPD LTx recipients, 3105 were included in the analytic sample, with multiple imputation used to complete missing data on covariates. Multivariable analysis found the hazard of death to increase with a 10 mmHg increase in mean pulmonary artery pressure (mPAP) among recipients of bilateral LTx (HR = 1.12; 95% CI = 1.01, 1.24; p = 0.032), but not among recipients of single LTx (HR = 0.92; 95% CI = 0.80, 1.06; p = 0.234).

Conclusion: PH prior to bilateral LTx in patients with COPD is associated with higher mortality risk.

Keywords: Bilateral; Chronic obstructive pulmonary disease; Lung transplantation; Pulmonary hypertension; Survival.

Publication types

Clinical Trial

MeSH terms

Aged
Cardiac Catheterization / methods
Catheterization, Swan-Ganz / methods
Databases, Factual
Female
Humans
Hypertension, Pulmonary / complications
Hypertension, Pulmonary / epidemiology
Hypertension, Pulmonary / mortality*
Hypertension, Pulmonary / physiopathology
Lung Transplantation / adverse effects
Lung Transplantation / mortality*
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive / epidemiology
Pulmonary Disease, Chronic Obstructive / mortality*
Pulmonary Disease, Chronic Obstructive / physiopathology
Pulmonary Disease, Chronic Obstructive / surgery*
Pulmonary Wedge Pressure / physiology*
Registries
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Analysis
Total Lung Capacity / physiology
Treatment Outcome
Vital Capacity / physiology
Walk Test / methods