title: Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: a UNOS registry analysis.
abstract: BACKGROUND
  Severe pre-transplant pulmonary hypertension (PH) has been associated with adverse short-term clinical outcomes after heart transplantation in relatively small single-center studies. The impact of pre-transplant PH on long-term survival after heart transplantation has not been examined in a large, multi-center cohort.
  
  
  METHODS
  Adults (≥18 years) who underwent first time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing registry. Pre-transplant PH was classified as mild, moderate, or severe based on pulmonary vascular resistance (PVR), trans-pulmonary gradient (TPG), and pulmonary artery (PA) mean pressure. Primary outcome was all-cause mortality.
  
  
  RESULTS
  Data from 26,649 heart transplant recipients (mean age 52±12 years; 76% male; 76% Caucasian) were analyzed. During a mean follow-up of 5.7±4.8 years, there were 10,334 (39%) deaths. Pre-transplant PH (PVR≥2.5 WU) was a significant predictor of mortality (hazard ratio 1.10, 95% confidence interval 1.05-1.14, p<0.0001) in multivariable analysis. However, the severity of pre-transplant PH (mild/moderate vs. severe) did not affect short or long-term survival. Similarly, even in patients who were supported with either a left ventricular assist device or a total artificial heart prior to transplant, severe pre-transplant PH was not associated with worse survival when compared to patients with mild/moderate pre-transplant PH.
  
  
  CONCLUSIONS
  Pre-transplant PH (PVR≥2.5 WU) is associated with a modest increase in mortality when compared to patients without pre-transplant PH. However, the severity of pre-transplant PH, assessed by PVR, TPG, or mean PA pressure, is not a discriminating factor for poor survival in patients listed for heart transplantation.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: vakil012@umn.edu.
authors.forename: Kairav
authors.initials: K
authors.lastname: Vakil
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Alok
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota and Veterans Affairs Medical Center, Minneapolis, MN, USA.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Kashan Syed
authors.initials: KS
authors.lastname: Abidi
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Taimeh
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin-Adams
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014655:Vascular Resistance / Q000502:physiology
keywords: Heart transplantation; Mortality; Pulmonary hypertension