The Evolution of Pulmonary Hypertension in Terminal Lung Failure

Objectives: Hemodynamic parameters are an important diagnostic tool for patients awaiting lung transplantation (LTX), not only concerning prognosis and further therapeutic options but also during the procedure considering the evaluation for extracorporeal membrane oxygenation. However, hemodynamic parameters are initially conducted at time of wait listing, but there is no guideline assessing the time point of reevaluation of hemodynamic parameters. The present study aimed to assess the hemodynamic changes in patients undergoing lung transplantation between time of wait listing and LTX.

Methods: All patients undergoing LTX between December 2011 and December 2017 were retrospectively analyzed (n = 351). Patients were screened for their right heart catheterization at time of listing and hemodynamic parameters during lung transplantation.

Results: There was a significant change in mPAP values from wait listing to first measured value by use of a pulmonary artery catheter at the beginning of LTX in all patients. Divided by diagnosis, patients with COPD had the lowest increase in mPAP values and ILD patients showed the highest rise in mPAP values (11.8 ± 9.9 vs. 19.3 ± 13.5; p = 0.264). There were no differences in survival probabilities after LTX between patients divided by mPAP value at time of wait listing (p = 0.87 by log-rank test).

Conclusion: Our data suggest closer monitoring of hemodynamic parameters in patients listed for LTX, particularly in ILD patients, for proper planning of perioperative use of extracorporeal circulation.