Pulmonary hypertension lung transplantation

The first combined heart-lung transplant was performed in 1981 at Stanford University. Combined heart-lung donors need to satisfy both the requirements already described separately. Combined heart-lung transplant is recommended in patients with congenital problems affecting these organs, pulmonary hypertension and/or cystic fibrosis. The recipients for the combined transplant are recommended to be less than 55 years old. Survival rates are 79, 66, and 54% at 1 month, 1 year and 3 years, respectively, after transplantation. 

Higenbottam TW, Spiegelhalter D, Scott JP, Fuster V, Dinh-Xuan AT, Caine N, Wallwork J. Prostacyclin (epo-prostenol) and heart-lung transplantation as treatments for severe pulmonary hypertension. Br Heart J 1993 70(4) 366-70. 

The problems of transplanted organs are legion, and lung transplantation is probably one of the most difficult transplants to maintain. Aerosol applications may play a role. Major problems include transplant rejection, pulmonary hypertension, infection, and progressive bronchial obstruction caused by an immune response in the airways. 

Perez-Enguix D, Morales P, Tomas JM, et al. Computed tomographic screening of pulmonary arterial hypertension in candidates for lung transplantation. Transplantation Proc 2007 39 2405-8. 

Pulmonary hypertension is a rare idiopathic disease that mainly affects young adults. It leads to right-sided heart failure and frequently is fatal. Long-term therapy with PGI2 (epoprostenol, Flolan) has either delayed or precluded the need for lung or heart-lung transplantation in a number of patients. In addition, many affected individuals have had a marked improvement in symptoms after receiving treatment... 

We investigated 11 patients (median age 13 years range, 0.7-27 years with pulmonary hypertension (mean pulmonary artery pressure, 71.6 8.4 mm Hg) who underwent cardiac catheterization as a prelude to transplantation of the heart, the lungs, or both. The patients were divided into two groups on the basis of left atrial pressure. Six patients had high mean left atrial pressures (27.0 4.2 mm Hg), elevated pulmonary ventricular resistance (mean, 14.9 3.8 U m ), and transpulmonary gradient (mean,... 

Elevated pulmonary vascular resistance is a risk factor prior to cardiac transplantation which is manifested by an increased risk of right ventricular failure postoperatively. " Nevertheless, patients with left atrial hypertension may have a reversible component to their pulmonary hypertension if the underlying cause can be relieved. Therefore, assessment of the degree of pulmonary vasoconstriction assumes importance prior to transplantation. The limited number of donor organs dictates that accurate assessment of pulmonary vascular disease be made in order to limit combined heart-lung transplantation and ensure more effective use of scarce resources. 

Tan RT, Kuzo R, Goodman LR, et al. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest 1998 113(5) 1250-1256. 

Schachna L, Medsger TA Jr., Dauher JH, et al. Lung transplantation in scleroderma compared with idiopathic pulmonary fihrosis and idiopathic pulmonary arterial hypertension. Arthritis Rheum 2006 54 3954-3961. 

Pierson in RN, Kaspar-Konig W, Tew DN, Yoimg VK, Braidley PC, White DJ, Wallwotk J. Profound pulmonary hypertension characteristic of pig lung rejection by human blood is mediated by xenoteactive antibody independent of complement Transplant Proc 1995 27 274. 

Strueber, M., Hoeper, M.M., and Fischer, S. 2009. Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device. Am f Transpl 4 853-7. 

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