PURPOSE: Pulmonary hypertension (PH) is common in advanced COPD with published incidences around 50% in the literature. PH is an important predictor of mortality in COPD. We attempted to characterize the prevalence of PH in a large cohort of patients with COPD listed for lung transplant.
METHODS: Retrospective review of the United Network for Organ Sharing (UNOS) database of patients listed for transplant due to COPD.
RESULTS: 1133 patients with the diagnosis of COPD were listed for transplant over a 10 year period (1997-2006). Of these 456 (40%) were found to have a mean pulmonary artery pressure (mPAP) of greater than 25mmHg at rest. The presence of PH seemed to correlate with an increased oxygen requirement; 44% of patients with PH required greater than 3 lpm as opposed to 35% of those without PH. PH also appeared to influence functional capacity as measured by the Six Minute Walk Test; 24.1% of patients with PH walked less than 500 ft versus 16.5% of those without PH. Of those patients with Very Severe (FEV1 <25%) and Severe (FEV1 25-34%) COPD, 41% and 35% respectively had mPAPs greater than 25mmHg, while in the Moderate (FEV1 35%+) COPD group 49% of patients had PH.
CONCLUSION: PH is common in patients with severe COPD listed for lung transplant and its presence seems to correlate with decreased functional capacity and increased oxygen needs. There is also a suggestion of a group of patients with relatively preserved lung function who have worse hemodynamics which may be contributing to their need for transplantation.
CLINICAL IMPLICATIONS: Identification of COPD patients with relatively well-preserved lung function but increased pulmonary artery pressures may represent a subgroup of patients in whom PAH therapy might be of benefit.
DISCLOSURE: Michael Cuttica, No Financial Disclosure Information; No Product/Research Disclosure Information