title: Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.
abstract: BACKGROUND
  Increased pulmonary vascular resistance (PVR) is associated with increased right ventricular failure and mortality after heart transplantation.
  
  
  METHODS
  In this prospective study, 22 patients considered high-risk candidates for heart transplantation because of severe pulmonary hypertension (PVR = 6 ± 2 Wood units; transpulmonary gradient 22 ± 7 mmHg), received bosentan 125 mg bid. Right heart catheterization was repeated after four months (n = 22) and 12 months (n = 9). Eleven patients who declined participation in the study were considered as control group.
  
  
  RESULTS
  After four months, PVR decreased by 38% in patients receiving bosentan (n = 22), while it increased by 25% in the control group (p = 0.001). Those patients who received bosentan for 12 months (n = 9), experienced a 60% reduction in PVR compared to baseline (p = 0.003). Only three patients (14%) had no hemodynamic improvement with bosentan. After bosentan therapy, 14 patients (64%) underwent heart transplantation. Patients with high PVR who received bosentan showed a trend toward better one-yr survival after transplantation than patients with PVR ≤ 2.5 Wood units transplanted in the same period of time (93% vs. 83%).
  
  
  CONCLUSIONS
  In patients considered high-risk candidates for heart transplantation because of high PVR, therapy with bosentan is associated with a significant reduction in PVR and a good outcome after transplantation.
authors.affiliation: Heart Failure and Heart Transplantation Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain. fperez@clinic.ub.es
authors.forename: Felix
authors.initials: F
authors.lastname: Perez-Villa
authors.forename: Marta
authors.initials: M
authors.lastname: Farrero
authors.forename: Montse
authors.initials: M
authors.lastname: Cardona
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Castel
authors.forename: Irene
authors.initials: I
authors.lastname: Tatjer
authors.forename: Diego
authors.initials: D
authors.lastname: Penela
authors.forename: Isabel
authors.initials: I
authors.lastname: Vallejos
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077300:Bosentan; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012449:Safety; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan