IMPACT OF PULMONARY-HYPERTENSION ON OUTCOME AFTER SINGLE-LUNG TRANSPLANTATION

Single lung transplantation for pulmonary hypertension (PH) remains a controversial therapy. We retrospectively studied 48 consecutive recip ients of single-lung allografts to determine if preoperative PH was as sociated with increased mortality or morbidity. Recipients were divide d into two groups; those who did not have preoperative PH, defined as mean pulmonary arterial pressure less than or equal to 30 mm Hg (n = 2 9; group 1), and those recipients with PH who had a mean pulmonary art erial pressure greater than 30 mm Hg (n = 19; group II). Mean pulmonar y arterial pressure and pulmonary vascular resistance decreased signif icantly after transplantation in recipients with PH. These values rema ined significantly higher as compared with those in recipients without pretransplantation PH. Postoperative pulmonary ventilation/perfusion scans demonstrated significant ventilation/perfusion mismatch in lung allografts with pretransplantation PH (p < 0.05). The mean duration of intensive care unit stay was significantly longer in recipients with PH. Although operative mortality was similar between the groups, preop erative PH was associated with significantly lower 1-year survival (53 % versus 72%; p < 0.05) and New York Heart Association functional clas s (p < 0.05). We conclude that preoperative PH in single-lung transpla nt recipients is associated with significantly increased mortality, pr olonged intensive care unit stay, and less symptomatic improvement. Th us, despite a shortage of donor organs, single-lung transplantation ma y be suboptimal therapy in patients with PH. Further study comparing s ingle versus bilateral lung transplantation for PH is necessary.