Is partially reversible pulmonary hypertension a contraindication for heart transplantation?

Pre-transplant reversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation

“…Data comparing pulmonary hypertension (especially "reversible") and mortality post-transplant remain controversial. 5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] There are many reasons for these varied findings. Differences in recipient age studied (some including pediatric patients), definition of pulmonary hypertension used, inclusion of data on whether reversibility was assessed or not (and, if so, the extent to which it reversed), whether or not the mortality data were risk-adjusted, short vs long-term outcome assessment, different statistical methods and approach to missing data applied, etc., are a few reasons why these studies have shown conflicting results.…”

Regression of “fixed” pulmonary vascular resistance in heart transplant candidates after unloading with ventricular assist devices

“…This observation was confirmed by other authors in the following years. [14][15][16] In the year 2000 we have started to implant left ventricular assist devices (LVAD) in patients with fixed PVR for destination therapy. A significant reduction in PVR was observed after several months of mechanical circulatory support.…”

Heart transplantation in children with markedly elevated pulmonary vascular resistance: Impact of right ventricular failure on outcome

“…[1][2][3][4] In fact, data from the International Society of Heart and Lung Transplantation (ISHLT) annual report in 1993 indicated that RV dysfunction accounted for 50% of all post-transplant cardiac complications and 19% of all early deaths. 5 Since the early days, high PVR in most centers has been considered an exclusion criterion for heart transplantation, 6,7 whereas in others, such patients are only considered for the higher-risk heart-lung transplantation. 6,8 Although orthotopic heart transplantation has been successful in adults and children with elevated PVR, controversy remains about what level of elevation of PVR should be considered an absolute contraindication to heart transplant.…”

“…5 Since the early days, high PVR in most centers has been considered an exclusion criterion for heart transplantation, 6,7 whereas in others, such patients are only considered for the higher-risk heart-lung transplantation. 6,8 Although orthotopic heart transplantation has been successful in adults and children with elevated PVR, controversy remains about what level of elevation of PVR should be considered an absolute contraindication to heart transplant.…”