title: Preoperative pulmonary artery pressure and mortality after lung transplantation.
abstract: BACKGROUND
  The purpose of this study was to determine the influence of changes in pulmonary artery pressure during the waiting period on survival after lung transplantation for pulmonary fibrosis.
  
  
  METHODS
  We identified 65 patients with pulmonary fibrosis who underwent lung transplantation from 2003 to 2010. Pulmonary artery pressure determined at listing was compared with intraoperative pressure. The primary outcome was overall survival. Co-variates included type of transplantation (single or bilateral), ischemic time, recipient and donor age and sex.
  
  
  RESULTS
  The median age of the 65 patients undergoing transplantation was 58 years, and 27 (43%) underwent bilateral sequential transplantation. Twenty-two (35%) patients presented at transplantation with a mean pulmonary artery pressure increased by at least 10% compared to the initial pressure at the time of listing. Rising pulmonary artery pressure at transplantation was associated with increased mortality (p = 0.022). Other factors including type of operation, ischemic time, age, and sex, were not significantly associated with mortality. Post-transplantation survival was worse among recipients who had pulmonary artery pressure increased by at least 10% at transplantation (p = 0.003, logrank).
  
  
  CONCLUSIONS
  Increasing pulmonary artery pressure while awaiting lung transplantation is associated with worse long-term survival following transplantation, and is a sign of progressively worsening disease for which greater urgency of donor organ allocation should be considered.
authors.affiliation: Departments of Surgery and Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Flaherty
authors.forename: Jules
authors.initials: J
authors.lastname: Lin
authors.forename: Vibha N
authors.initials: VN
authors.lastname: Lama
authors.forename: Rishindra M
authors.initials: RM
authors.lastname: Reddy
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Chan
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D001795:Blood Pressure Determination; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hypertension; lung transplantation; pulmonary; pulmonary fibrosis; survival analysis