title: Cautious epoprostenol therapy is a safe bridge to lung transplantation in pulmonary veno-occlusive disease.
abstract: Pulmonary veno-occlusive disease (PVOD) carries a poor prognosis and lung transplantation is the only curative treatment. In PVOD, epoprostenol therapy is controversial, as this condition may be refractory to specific therapy with an increased risk of pulmonary oedema. We retrospectively reviewed clinical, functional and haemodynamic data of 12 patients with PVOD (10 with histological confirmation) treated with continuous intravenous epoprostenol and priority listed for lung transplantation after January 1, 2003. All PVOD patients had severe clinical, functional and haemodynamic impairment at presentation. Epoprostenol was used at low dose ranges with slow dose increases and high dose diuretics. Only one patient developed mild reversible pulmonary oedema. After 3-4 months, improvements were seen in the New York Heart Association functional class (class IV to III in seven patients), cardiac index (1.99+/-0.68 to 2.94+/-0.89 L x min(-1) x m(-2)) and indexed pulmonary vascular resistance (28.4+/-8.4 to 17+/-5.2 Wood units x m(-2); all p<0.01). A nonsignificant improvement in the 6-min walk distance was also observed (+41 m, p = 0.11). Two patients died, one patient was alive on the transplantation waiting list on December 1, 2008 and nine patients were transplanted. Cautious use of continuous intravenous epoprostenol improved clinical and haemodynamic parameters in PVOD patients at 3-4 months without commonly causing pulmonary oedema, and may be a useful bridge to urgent lung transplantation.
authors.affiliation: Université Paris-Sud, Faculté de médecine, Centre National de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, AP-HP, INSERM U999, Hôpital Antoine Béclère, Clamart, France.
authors.forename: D
authors.initials: D
authors.lastname: Montani
authors.forename: X
authors.initials: X
authors.lastname: Jaïs
authors.forename: L C
authors.initials: LC
authors.lastname: Price
authors.forename: L
authors.initials: L
authors.lastname: Achouh
authors.forename: B
authors.initials: B
authors.lastname: Degano
authors.forename: O
authors.initials: O
authors.lastname: Mercier
authors.forename: S
authors.initials: S
authors.lastname: Mussot
authors.forename: E
authors.initials: E
authors.lastname: Fadel
authors.forename: P
authors.initials: P
authors.lastname: Dartevelle
authors.forename: O
authors.initials: O
authors.lastname: Sitbon
authors.forename: G
authors.initials: G
authors.lastname: Simonneau
authors.forename: M
authors.initials: M
authors.lastname: Humbert
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D011668:Pulmonary Veno-Occlusive Disease / Q000188:drug therapy* / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol