Impact of postoperative pulmonary hypertension on outcome after heart transplantation.

OBJECTIVES

We wanted to investigate the effects of postoperative pulmonary hypertension (PH: mean pulmonary artery pressure [MPAP] ≥ 25 mmHg), diastolic pressure gradient (DPG), pulmonary vascular resistance (PVR), and repeated hemodynamic measurements on long-term survival after heart transplantation (HT).

DESIGN

Eighty-nine patients who underwent HT at Skåne University Hospital in Lund in the period 1988-2010 and who were evaluated with right-heart-catheterization at rest, prior to HT and repeatedly during the first postoperative year, were grouped based on their MPAP, DPG, and PVR.

RESULTS

One year after HT, survival was lower in patients with PH than in those without, in patients with DPG ≥7 mmHg than in those with DPG <7 mmHg, and in patients with PVR >3 WU than in those with PVR ≤3 WU. Moreover, compared to patients with no PH or with PH at one evaluation during the first year after HT, PH at repeated evaluations was associated with higher mortality (hazard ratio 3.4, 95% CI 1.4-8.0). There was no significant difference in acute cellular rejection between patients with and without PH, but postoperative kidney function was worse in patients with repeated PH.

CONCLUSIONS

When defined according to present guidelines, PH one year after HT may emerge as a prognostic marker for long-term outcome after HT. Moreover, PH at repeated evaluations during the first year after HT had stronger prognostic value than PH at a single examination, illustrating a means of identifying a high-risk population. However, confirmation in larger multi-center studies is warranted.