title: Changes in pulmonary artery pressure affect survival differently in lung transplant recipients who have pulmonary hypertension or chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Pulmonary hypertension and right ventricular dysfunction can complicate lung transplant. Pulmonary artery pressures affect outcome are uncertain during wait list. We evaluated changes in wait list pulmonary artery pressures on survival after lung transplant.
  
  
  METHODS
  We queried the United Network for Organ Sharing/Standard Transplant Analysis and Research registry from 1987 to 2012 for all lung transplants. Recipients with unique pulmonary artery pressure measurements upon listing and transplant were included. Mean pulmonary artery pressure was rated as increased (increase > 5 mm Hg), decreased (decrease > 5 mm Hg), or unchanged (variation < 5 mm Hg).
  
  
  RESULTS
  There were 23 951 lung transplants and 1677 recipients were included. Diagnoses demonstrated significant changes in mean pulmonary artery pressure during the listing period (P ≤ .0001). In recipients with chronic obstructive pulmonary disease, survival was poorer when mean pulmonary artery pressure was increased than decreased (P ≤ .03). In recipients with primary pulmonary hypertension, survival was poorer when mean pulmonary artery pressure was decreased than increased (P ≤ .02). Proportional hazards analysis showed that increases in mean pulmonary artery pressure independently affected survival (hazard ratio, 0.78; 95% confidence interval, 0.62-0.96).
  
  
  CONCLUSIONS
  Although the mechanism is unknown, an increase in mean pulmonary artery pressure in patients with chronic obstructive pulmonary disease is associated with poorer survival after lung transplant. In contrast, patients with primary pulmonary hypertension with decreased mean pulmonary artery pressure have poorer survival after lung transplant. In patients with primary pulmonary hypertension, changes in pulmonary artery pressure may be a surrogate for a failing right ventricular function. In chronic obstructive pulmonary disease, the change in pressure suggests an undetermined progressive process. Further study of right ventricular function is warranted to determine the effects of changes in pulmonary artery pressure on lung transplant recipients.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center, Ohio State University, OH, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: O'Keefe
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.forename: Amy
authors.initials: A
authors.lastname: Pope-Harman
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.forename: Stephen
authors.initials: S
authors.lastname: Kirkby
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
mesh_terms: D062186:Arterial Pressure; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists