Preoperative echocardiographic-defined moderate-severe pulmonary hypertension predicts prolonged duration of mechanical ventilation following lung transplantation for patients with COPD.

PURPOSE

Recent studies have suggested that pretransplant secondary pulmonary hypertension (PHT) may be associated with worse outcomes following lung transplantation. We sought to determine whether COPD patients with secondary PHT have inferior intensive care outcomes following lung transplantation.

METHODS

This is a single-center, retrospective analysis of all lung transplant recipients between 2000 and 2009 for a primary diagnosis of COPD. Patients were stratified a priori into three pulmonary arterial pressure groups based on right ventricular systolic pressure (RVSP): no PHT (RVSP < 35 mmHg), mild PHT (35 ≤ RVSP < 45 mmHg), and moderate-severe PHT (RVSP ≥ 45 mmHg). Outcome measures were duration of mechanical ventilation, intensive care unit (ICU) length of stay, and PaO(2)/fraction inspired oxygen (PaO(2)/F(I)O(2)) ratio at 24 h posttransplantation.

RESULTS

A total of 46 COPD lung transplant recipients with documented pretransplant RVSP were included in the analysis, including 18 with no PHT, 20 with mild PHT, and eight with moderate-severe PHT. There were no differences in baseline demographics between the three pulmonary arterial pressure groups. The presence of moderate-severe PHT predicted increased duration of mechanical ventilation (P = 0.024), worse PaO(2)/F(I)O(2) ratio at 24 h (P = 0.027), and a trend toward increased ICU length of stay (P = 0.055). RVSP was the strongest risk factor for duration of mechanical ventilation and ICU length of stay. There was no difference in 1-year survival amongst the three pulmonary arterial pressure groups.

CONCLUSIONS

Preoperative moderate-severe PHT predicts prolonged duration of mechanical ventilation following lung transplantation in COPD subjects.