title: Reversible pulmonary hypertension in heart transplant candidates: to transplant or not to transplant.
abstract: BACKGROUND
  Pulmonary hypertension (PHT), defined as a pulmonary vascular resistance (PVR) greater than 2.5 Wood units [WU] and(or) transpulmonary gradient (TPG) greater than 12 mm Hg, is a risk factor for mortality in cardiac transplantation due to elevated postoperative right heart failure. Orthotopic heart transplantation is possible if PVR could be reversed below 2.5 WU and TPG below 12 mm Hg. We show the Muenster experience from the last 10 years.
  
  
  METHODS
  From April 1996 to December 2005 all cardiac transplant recipients separated into patients with and without PHT were included. All patients with PHT had successful reduction (PVR < or = 2.5 WU and TPG < or = 12 mm Hg) using prostaglandin I2 or E1. Posttransplant early and late mortality and incidence of right heart failure were studied.
  
  
  RESULTS
  Two hundred seventeen patients were included in this study. Of these, 168 had normal pulmonary pressures (non-PHT group), 49 (22.6%) had reversible PHT (rev-PHT group). Mean PVR was 1.6 +/- 1.1 WU vs 2.1 +/- 1.1 WU (p < 0.01; non-PHT vs rev-PHT) and mean TPG 8.0 +/- 1.9 mm Hg vs 10.6 +/- 4.1 mm Hg (p = not significant [NS]). Thirty-day survival after orthotopic cardiac transplantation was 85% vs 78% (p = 0.150) and 10 year survival 63% vs 61% (p = NS). Right heart failure during the first 30 days after transplantation occurred in 27% in the non-PHT group and in 64% in the rev-PHT group (p = 0.035). However, in patients transplanted after 2001 it did not appear.
  
  
  CONCLUSIONS
  Cardiac transplant candidates with reversible PHT have still significantly elevated pulmonary pressures compared with patients without PHT. Despite a significantly higher risk of right heart failure, long-term survival after orthotopic cardiac transplantation was not affected.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. stefan.klotz@ukmuenster.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Klotz
authors.forename: Frauke
authors.initials: F
authors.lastname: Wenzelburger
authors.forename: Joerg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.forename: Gabriele
authors.initials: G
authors.lastname: Drees
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D011464:Epoprostenol / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011453:Prostaglandins / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D011453:Prostaglandins; D011464:Epoprostenol; D000527:Alprostadil