Miller Michael S, Johnson Shelsey W, Opotowsky Alexander R, Landzberg Michael J, Sharma Nirmal S, Goldberg Hilary J, Wong Alexandra K, Witkin Alison S, Rodriguez-Lopez Josanna, Goldstein Ronald H, Maron Bradley A, Wertheim Bradley M
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JHLT Open. 2024 Apr 20;5:100098. doi: 10.1016/j.jhlto.2024.100098. eCollection 2024 Aug.
Esophageal dysmotility is identified as a contraindication to lung transplantation at some centers due to increased risks of acute rejection, pulmonary infection, and chronic lung allograft dysfunction. Phosphodiesterase-type 5 inhibitors (PDE5i) are a cornerstone pharmacotherapy for pulmonary arterial hypertension (PAH) and are known to exert off-target effects that may impact lung transplant candidacy, including impaired esophageal contractility and decreased lower esophageal sphincter tone. We report 2 patients with PAH who were initially declined listing for lung transplantation due to iatrogenic esophageal dysmotility induced by PDE5is. Upon discontinuation of PDE5i therapy, these patients experienced significant improvement in esophageal motility within 14 days and met the criteria for transplant listing at their centers. Recognizing and mitigating the off-target effects of PDE5i medications is critical for maximizing access to transplant for patients with PAH.
在一些中心，食管动力障碍被视为肺移植的禁忌症，因为急性排斥反应、肺部感染和慢性肺移植功能障碍的风险增加。5型磷酸二酯酶抑制剂（PDE5i）是肺动脉高压（PAH）的基石药物治疗方法，已知其会产生可能影响肺移植候选资格的脱靶效应，包括食管收缩力受损和食管下括约肌张力降低。我们报告了2例PAH患者，他们最初因PDE5i引起的医源性食管动力障碍而被拒绝列入肺移植名单。停用PDE5i治疗后，这些患者在14天内食管动力有显著改善，并符合其所在中心的移植名单标准。认识并减轻PDE5i药物的脱靶效应对于最大限度地为PAH患者提供移植机会至关重要。
