ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Impact of Peri-Operative Pulmonary Hypertension in Lung Transplant Recipients on Early Post-Operative Outcomes
Session Title
TP23 - TP023 LUNG TRANSPLANT: OUTCOME PREDICTORS AND THERAPEUTIC OPTIONS
Abstract
A1775 - Impact of Peri-Operative Pulmonary Hypertension in Lung Transplant Recipients on Early Post-Operative Outcomes
Author Block: O. A. O'Corragain1, R. M. Marron1, S. Tittaferrante2, O. Schanz2, J. Noto2, R. Khatri2, H. Zhao3, G. J. Criner1, P. Rali1, S. Sehgal1, J. I. Stewart1; 1Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, United States, 2Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 3Clinical Sciences, Temple University Hospital, Philadelphia, PA, United States.
Rationale: Pulmonary hypertension (PH) is a common finding in patients undergoing lung transplantation. Elevated mean pulmonary arterial pressure (mPAP) prior to lung transplantation has been associated with higher rates of primary graft dysfunction (PGD). PGD has been associated with worsened 90-day and 1 year outcomes, higher rates of post-operative complications and bronchiolitis obliterans syndrome. mPAP is expected to improve following lung transplantation, but may not completely normalize, particularly in patients receiving single lung transplantation. The aim of our study was to evaluate the effect of mPAP post-operatively on rates of early post-operative complications and primary graft dysfunction.
Methods: All patients who underwent lung transplantation at Temple University Hospital (Philadelphia, PA) between January 2017 and September 2020 for whom data was available were evaluated. Patients were stratified based on an immediate post-operative (end of case) mPAP of <25mmHg or ≥25mmHg measured by Swan-ganz catheters. Patient demographics, pre-operative, intraoperative and post-operative hemodynamic data, and outcome measures were collected. PGD diagnosis was based on ISHLT guidelines as documented during admission. Statistical analysis was performed using Wilcoxon analysis for continuous variables and Fisher's Exact test and Chi-Square test for categorical variables.
Results: 226 lung transplant recipients were identified ( DLT 28.76%, SLT 70.35%, HLT 0.88%). The main indications for transplant were ILD (61.1%) and COPD (24.7%). Baseline mPAP and pulmonary vascular resistance (PVR) were similar across both groups (28.4 vs 26.8, p=021, 4.19 vs 3.9, p=013). Immediately post-transplant, 120 (53%) patients had an elevated (≥25mmHg) mPAP and 106 (47%) patients had a normalized mPAP (<25). Patients in the elevated mPAP group received a higher proportion of single lung transplants (77.5% vs 62.26%, p=0.022). Patients in the elevated mPAP group had worsen P/F ratio at day 3 (230.69 vs 292.02, p=0.028) and had a trend toward higher rates of PGD at 72 hours (45.83% vs 34.9%, p=0.095). There was no difference in ICU or hospital length of stay, need for supplemental O2 at day 7, inpatient mortality or 1 year survival.
Conclusions: Persistent pulmonary hypertension (mPAP > 25) in the immediate post-transplant period is associated with worse oxygenation and a trend towards higher incidence of PGD at 72 hours in lung transplant recipients.
Author Block: O. A. O'Corragain1, R. M. Marron1, S. Tittaferrante2, O. Schanz2, J. Noto2, R. Khatri2, H. Zhao3, G. J. Criner1, P. Rali1, S. Sehgal1, J. I. Stewart1; 1Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, United States, 2Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 3Clinical Sciences, Temple University Hospital, Philadelphia, PA, United States.
Rationale: Pulmonary hypertension (PH) is a common finding in patients undergoing lung transplantation. Elevated mean pulmonary arterial pressure (mPAP) prior to lung transplantation has been associated with higher rates of primary graft dysfunction (PGD). PGD has been associated with worsened 90-day and 1 year outcomes, higher rates of post-operative complications and bronchiolitis obliterans syndrome. mPAP is expected to improve following lung transplantation, but may not completely normalize, particularly in patients receiving single lung transplantation. The aim of our study was to evaluate the effect of mPAP post-operatively on rates of early post-operative complications and primary graft dysfunction.
Methods: All patients who underwent lung transplantation at Temple University Hospital (Philadelphia, PA) between January 2017 and September 2020 for whom data was available were evaluated. Patients were stratified based on an immediate post-operative (end of case) mPAP of <25mmHg or ≥25mmHg measured by Swan-ganz catheters. Patient demographics, pre-operative, intraoperative and post-operative hemodynamic data, and outcome measures were collected. PGD diagnosis was based on ISHLT guidelines as documented during admission. Statistical analysis was performed using Wilcoxon analysis for continuous variables and Fisher's Exact test and Chi-Square test for categorical variables.
Results: 226 lung transplant recipients were identified ( DLT 28.76%, SLT 70.35%, HLT 0.88%). The main indications for transplant were ILD (61.1%) and COPD (24.7%). Baseline mPAP and pulmonary vascular resistance (PVR) were similar across both groups (28.4 vs 26.8, p=021, 4.19 vs 3.9, p=013). Immediately post-transplant, 120 (53%) patients had an elevated (≥25mmHg) mPAP and 106 (47%) patients had a normalized mPAP (<25). Patients in the elevated mPAP group received a higher proportion of single lung transplants (77.5% vs 62.26%, p=0.022). Patients in the elevated mPAP group had worsen P/F ratio at day 3 (230.69 vs 292.02, p=0.028) and had a trend toward higher rates of PGD at 72 hours (45.83% vs 34.9%, p=0.095). There was no difference in ICU or hospital length of stay, need for supplemental O2 at day 7, inpatient mortality or 1 year survival.
Conclusions: Persistent pulmonary hypertension (mPAP > 25) in the immediate post-transplant period is associated with worse oxygenation and a trend towards higher incidence of PGD at 72 hours in lung transplant recipients.
