PURPOSE: To determine the effect of preexisting secondary pulmonary hypertension (PHTN) prior to lung transplantation (LT) on post transplant outcomes (acute rejection, mortality, obliterative bronchiolitis [OB]).
METHODS: Retrospective chart review of all patients with history of LT prior to 12/31/2006 was done. Exclusion criteria include patients with lack of adequate documentation, failure to follow up for 2 years, anastomotic complications. This is a pilot study of 24 patients and descriptive statistics were used to analyze the data.
RESULTS: There were 24 patients in the study. Mean age was 55. Patients were transplanted for chronic obstructive lung disease (67%) diffuse parenchymal lung disease(21 %), sarcoid (8%), bronchiectasis (4%). Mean duration of follow up was 44 months. Single LT (54)% and double lung transplants (46%) respectively. Acute rejection episodes varying from A1 to A4 were 87.5%. 71% of this group of patients had preexisting secondary pulmonary hypertension. 58% had OB at the time of the study. Mean duration from the time of transplant to the time of onset of OB was 511 days. Mortality in this group was 25%. 67% in these patients who died had PHTN and 83% developed OB prior to death. Among patients with OB, 64% had preexisting pulmonary hypertension. The rejection episodes in patients with no OB were (70%) and all patients with OB had episodes of acute rejection during their follow up period. Patients with and without preexisting pulmonary hypertension had similar rejection episodes (88%) and (86%) respectively.
CONCLUSION: There is a trend towards increasing development of OB in patients with preexisting PHTN. The mortality in this group also appears to be higher. Rejection episodes were similar in patients with and without PHTN. Limitations for the study include, small sample size, lack of donor information,ischemic times. Larger multicenter study in needed to confirm the results of this study.
CLINICAL IMPLICATIONS: Further immunological studies to identify markers( protein biomarkers, gene expression pattern) in this high risk group will help in early recognition and target therapeutic strategies for the same.
DISCLOSURE: Mohammad Omari, No Financial Disclosure Information; No Product/Research Disclosure Information