PURPOSE: Bronchiolitis Obliterans (BO), the pathologic correlate of chronic allograft rejection, complicates the course of many lung transplant recipients. We sought to characterize the prevalence of pulmonary hypertension (PH) complicating the course of patients who develop this entity.
METHODS: Retrospective review of the United Network for Organ Sharing (UNOS) database of patients re-listed for transplant due to BO.
RESULTS: 386 patients with a diagnosis of BO were re-listed for transplant over a 10 year period (1997-2006). Of these, 66.7% had bilateral lung transplants and the remainder were single lung recipients. The most common primary diseases were Cystic Fibrosis (CF) (37.6%), COPD (19.4%), IPF (14.7%) and PPH (9.8%). The time periods between the initial transplant and re-listing was < 2 years in 33.5%, 2-5 years in 35% and >5 years in 31.5% of the recipients. The mean Pulmonary Artery Pressure (mPAP) was available in only 80 of the patients, 49 (61.25%) of whom were bilateral and 31 (38.75%) single lung recipients. Of this final cohort, 31.25% had mPAP<20mmHg, 36.25% had mPAP of 20-25mmHg, and the remaining 32.5% had PH as defined by a mPAP>25mmHg. 13/49 (26.5%) of the bilateral recipients had PH at re-listing versus 13/31 single recipients (42%). At re-listing, PH was present in11/28 (39.2%) COPD patients, 6/27 (22.2%) of CF patients, 36.4 (4/11) IPF patients and 42.8% (3/7) of PPH patients.
CONCLUSION: PH is common in patients who are re-listed for lung transplantation. Whether this should be a target for therapy and therefore more readily sought requires further study.
CLINICAL IMPLICATIONS: The development of PH in patients with BOS might have important implications for the prognosis and therapy of this condition.
DISCLOSURE: Steven Nathan, No Financial Disclosure Information; No Product/Research Disclosure Information