Pulmonary haemodynamics after single-lung transplantation for end-stage pulmonary parenchymal disease

Abstract

P Pu ul lm mo on na ar ry y h ha ae em mo od dy yn na am mi ic cs s a af ft te er r s si in ng gl le e--l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n f fo or r e en nd d--s st ta ag ge e p pu ul lm mo on na ar ry y p pa ar re en nc ch hy ym ma al l d di is se ea as se e ABSTRACT: In a prospective study, we investigated the effect of single-lung transplantation (SLT) on pulmonary haemodynamics and the relationship between pulmonary hypertension (PH) and the fraction of perfusion to the transplant in patients with end-stage pulmonary parenchymal disease.Twenty four SLT recipients were included in the study, 19 with chronic obstructive pulmonary disease (COPD), two with sarcoidosis and three with fibrosing alveolitis. Spirometry, determination of arterial blood gas values, perfusion scintigraphy and right heart catheterization were performed before and 1, 6, 12 and 24 months after transplantation. Patients with a mean pulmonary artery pressure (Ppa) ≥20 mmHg before transplantation were defined as having PH (PH group, 15 patients) and the remainder (9 patients) constituted the non-PH group.In the PH group, Ppa and pulmonary vascular resistance (PVR) were significantly decreased after transplantation: 28±2 to 18±1 mmHg and 288 to 161±11 dyne·s -1 ·cm -5 , respectively (mean±SEM). In the non-PH group, the haemodynamic parameters were unchanged after transplantation. Over the 2 year follow-up period, no significant change was found in Ppa and PVR, nor any difference between the PH and non-PH group. There was no significant difference between the two groups in terms of pulmonary perfusion to the graft.In conclusion, patients with pulmonary hypertension obtain pulmonary haemodynamics within the normal range after single-lung transplantation. Presence or absence of pulmonary hypertension before transplantation does not influence perfusion to the graft. These findings persist up to 2 yrs, despite the coexistence of an "end-stage" native lung and a lung transplant.

Pulmonary hypertension in COPD

“…BJORTUFT et al [131] have investigated a group of 24 patients, including 19 with COPD, who underwent single lung transplantation. The majority (15 out of 24) of patients had mild-to-moderate PH at the onset and in these patients P pa mean¡SEM significantly decreased from 28¡1 mmHg to 18¡1 mmHg after transplantation; there was a similar decrease in PVR.…”

Assessment of Pulmonary Artery Systolic Pressures by Stress Doppler Echocardiography After Bilateral Lung Transplantation

“…In other studies in which hemodynamic measurements were performed, demonstrating normal mean pulmonary artery pressure and cardiac output after lung transplantation, values during exercise were not obtained. 5,12,14,15 PASP values of Ͼ40 mm Hg during low-dose exercise have been shown to be related to the genotype of familial PAH 21 and to be a risk factor for the development of a manifest PAH in patients with scleroderma. 28 Three of 9 BLTx recipients assessed in this study had PASP values in the range of 45 to 48 mm Hg during exercise.…”

“…8 -11 It is not known if persistent or recurrent pulmonary hypertension with increased pulmonary artery pressure, or right ventricular dysfunction during exercise, may also contribute to impaired exercise capacity in BLTx recipients. Only a few studies have analyzed pulmonary hemodynamics 6 to 24 months after SLTx using right heart catheterization [12][13][14][15] or echocardiography. 15 Although most of these studies 12,14,15 showed normal pulmonary artery pressures after SLTx at rest, Ross et al found in 6 of 7 patients recurrent manifest pulmonary hypertension or latent pulmonary hypertension with elevated mean pulmonary artery pressures during exercise.…”

“…Only a few studies have analyzed pulmonary hemodynamics 6 to 24 months after SLTx using right heart catheterization [12][13][14][15] or echocardiography. 15 Although most of these studies 12,14,15 showed normal pulmonary artery pressures after SLTx at rest, Ross et al found in 6 of 7 patients recurrent manifest pulmonary hypertension or latent pulmonary hypertension with elevated mean pulmonary artery pressures during exercise. 13 Elevated plasma serotonin levels, which contribute to the development of pulmonary hypertension, have been documented in PAH patients after lung transplantation.…”

Graft Side-mismatching for Single-lung Transplantation Does Not Affect Outcomes: Role of the Pre-operative Quantitative Lung Perfusion Scan

“…We are not aware of any studies in which PVR was measured selectively in the native/transplanted lung post-operatively, but PVR does decrease overall after SLT. 8 Although QLPS is the accepted technique for evaluating relative lung perfusion, other techniques are available. Magnetic resonance imaging is able to measure blood flow in each lung, and compares favorably with QLPS in terms of accuracy in pre-operative assessment for SLT.…”