Effect of Preoperative Pulmonary Artery Pressure on Early Survival After Lung Transplantation for Idiopathic Pulmonary Fibrosis

Lung Size Mismatch and Primary Graft Dysfunction after Bilateral Lung Transplantation

“…In contrast, elevated pulmonary artery pressures were reported in the setting of undersized pediatric and adult lobar lung transplantation 19,24 . Elevated pulmonary artery pressures at the time of transplant were identified as a risk factor for PGD 2,10 . Furthermore, pulmonary vascular resistance is related to the inflation state of the lung.…”

“…It is conceivable that differences in PGD rates are responsible for these early survival differences and that lung undersizing predisposes to PGD through mechanisms involving both the pulmonary vasculature, as well as through potentially injurious tidal volumes during mechanical ventilation. A significantly undersized pulmonary vasculature could result in higher pulmonary arterial pressure at reperfusion, which is a risk factor for PGD 2,10 . Alternately, variability in size matching could result in different rates of PGD through differences in mechanical ventilation tidal volumes compared to donor lung size during the period of mechanical ventilation during and after lung transplantation.…”

Early Experience with Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis

“…The relative survival between single and bilateral lung transplant is controversial, with 1 report showing better survival with single lung transplant [13] and another study showing similar mortality for both single and bilateral lung transplant [14]. The largest study that has evaluated lung transplant for idiopathic pulmonary fibrosis included 830 patients from the International Society for Heart and Lung Transplant registry to evaluate the effect of preoperative pulmonary artery pressure; in that study, bilateral lung transplant had a greater risk of early mortality, and elevated pulmonary artery pressure increased the risk of mortality after single lung transplant [15].…”

Cardiac manifestations of idiopathic pulmonary fibrosis

“…Presence of PH also has an impact on transplant outcomes in patients with advanced lung disease. Whelan et al showed that increased PAP is associated with increased 90-day mortality post single-lung transplantation and 30-day mortality post double-lung transplant in patients with IPF (40).…”