Adverse Outcomes Associated with Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease After Bilateral Lung Transplantation

Background: The impact of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) on survival after lung transplantation (LTx) is not known.

Material And Methods: First-time adult LTx recipients with COPD transplanted between May 2005 and September 2013 were identified in the United Network for Organ Sharing Registry database, and tracked from transplant date until death or censoring. Right heart catheterization (RHC) measurements at time of wait listing were used to predict all-cause mortality after LTx, with multivariable analyses stratified by transplant type.

Results: Of 3362 COPD LTx recipients, 3105 were included in the analytic sample, with multiple imputation used to complete missing data on covariates. Multivariable analysis found the hazard of death to increase with a 10 mmHg increase in mean pulmonary artery pressure (mPAP) among recipients of bilateral LTx (HR = 1.12; 95% CI = 1.01, 1.24; p = 0.032), but not among recipients of single LTx (HR = 0.92; 95% CI = 0.80, 1.06; p = 0.234).

Conclusion: PH prior to bilateral LTx in patients with COPD is associated with higher mortality risk.