title: Pulmonary hypertension as a risk factor of mortality after lung transplantation.
abstract: OBJECTIVE
  Pulmonary hypertension (PH) is recognized as a risk factor in lung transplantation as reflected in the lung allocation score (LAS). We examined the impact of PH on outcome after lung transplantation, with special emphasis on pre- and post-capillary PH.
  
  
  METHODS
  Consecutive lung transplant recipients were evaluated according to ISHLT criteria including right heart catheterization in the period from 1992 to October 2014. Post-transplant survival was assessed according to hemodynamic characteristics: post-capillary PH (mean pulmonary arterial pressure [mPAP] ≥ 25 mmHg and pulmonary arterial wedge pressure [PAWP] > 15 mmHg), pre-capillary PH (mPAP ≥ 25 mmHg, PAWP ≤ 15 mmHg) and non-PH (mPAP < 25 mmHg).
  
  
  RESULTS
  Of 518 transplant recipients, 58 (11%) had post-capillary PH. Pre-capillary PH was present in 211 (41%) and 249 (48%) non-PH. Post-capillary PH and pre-capillary PH were associated with worse 90-d outcomes after transplantation compared to non-PH (p = 0.043 and 0.003, respectively). The negative effect persisted 1 yr post-transplantation in pre-capillary PH (p = 0.037), but not in post-capillary PH (p = 0.447). Long-term survival was unaffected by hemodynamic classification.
  
  
  CONCLUSIONS
  Post-capillary PH was present in 11% and pre-capillary PH in 41% of the transplant cohort. Post-capillary PH and pre-capillary PH were associated with inferior 90-d survival, but long-term survival was unaffected.
authors.affiliation: Department of Cardiology, Section for Pulmonary Hypertension and Right Heart Failure, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Kasper H
authors.initials: KH
authors.lastname: Andersen
authors.affiliation: Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Hans Henrik L
authors.initials: HH
authors.lastname: Schultz
authors.affiliation: Department of Cardiology, Section for Pulmonary Hypertension and Right Heart Failure, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nyholm
authors.affiliation: Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Iversen
authors.affiliation: Department of Cardiology, Section for Heart Transplantation, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.affiliation: Department of Cardiology, Section for Pulmonary Hypertension and Right Heart Failure, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Carlsen
mesh_terms: D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology; D006085:Graft Survival; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Lung transplantation; Primary graft dysfunction; Pulmonary hypertension