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National prevalence and clinical impact of pulmonary hypertension in adults listed for lung retransplantation for chronic lung allograft dysfunction.
СтатьяНазвание и аннотация: Перевод в очереди
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Charoenpong Prangthip, Wolf Keely, Banday Mudassir M, Goda Yasufumi, Suarez Eddie, Vahdatpour Cyrus, Pan Hao Min, Modi Dipaben Dhananjay, Segraves Justin, Syed Muhammad Khyzar Hayat, Potter Andrew S, Loor Gabriel, Li Gloria, Hayes Don, Fernandez Ramiro, Sharma Nirmal
Аннотация
BACKGROUND: Pulmonary hypertension (PH) has been described in chronic lung allograft dysfunction (CLAD), but its prevalence and prognostic significance in patients listed for lung retransplantation remain uncertain. We sought to determine the national prevalence of PH among adults listed for lung retransplantation for CLAD and to evaluate its association with waitlist and post-transplant outcomes.
METHODS: We analyzed SRTR data from May 2005 through September 2025 for adults listed for lung retransplantation for CLAD with right heart catheterization data at listing. PH was defined as mean pulmonary artery pressure (mPAP) greater than 20 mmHg. The primary outcome was waitlist mortality, analyzed using Fine-Gray competing-risk regression with transplantation treated as a competing event. Secondary outcomes included 30-day and 1-year post-transplant mortality.
RESULTS: Among 1440 eligible patients, 58% met hemodynamic criteria for PH at listing. PH prevalence did not differ between bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). In adjusted competing-risk models, PH was independently associated with increased waitlist mortality (Subdistribution hazard ratio 1.37, 95% CI 1.08-1.74). When mPAP was modeled continuously, higher pulmonary pressures were associated with progressively greater risk of waitlist mortality without a threshold effect. Among patients with complete hemodynamic data, pre-capillary PH was numerically more common in RAS than BOS (31.5% vs 28.2%), while isolated post-capillary PH (10.5% vs 9.9%) and combined pre/post-capillary PH (5.9% vs 7.0%) were similar. PH was not associated with 30-day or 1-year post-transplant mortality. Patients with PH were more likely to remain intubated at 72 hours after retransplantation, while other early postoperative outcomes were similar.
CONCLUSIONS: PH is common in adults listed for lung retransplantation for CLAD and is independently associated with increased waitlist mortality, but not early post-transplant mortality.
METHODS: We analyzed SRTR data from May 2005 through September 2025 for adults listed for lung retransplantation for CLAD with right heart catheterization data at listing. PH was defined as mean pulmonary artery pressure (mPAP) greater than 20 mmHg. The primary outcome was waitlist mortality, analyzed using Fine-Gray competing-risk regression with transplantation treated as a competing event. Secondary outcomes included 30-day and 1-year post-transplant mortality.
RESULTS: Among 1440 eligible patients, 58% met hemodynamic criteria for PH at listing. PH prevalence did not differ between bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). In adjusted competing-risk models, PH was independently associated with increased waitlist mortality (Subdistribution hazard ratio 1.37, 95% CI 1.08-1.74). When mPAP was modeled continuously, higher pulmonary pressures were associated with progressively greater risk of waitlist mortality without a threshold effect. Among patients with complete hemodynamic data, pre-capillary PH was numerically more common in RAS than BOS (31.5% vs 28.2%), while isolated post-capillary PH (10.5% vs 9.9%) and combined pre/post-capillary PH (5.9% vs 7.0%) were similar. PH was not associated with 30-day or 1-year post-transplant mortality. Patients with PH were more likely to remain intubated at 72 hours after retransplantation, while other early postoperative outcomes were similar.
CONCLUSIONS: PH is common in adults listed for lung retransplantation for CLAD and is independently associated with increased waitlist mortality, but not early post-transplant mortality.