Prognostic value of the pre-transplant diastolic pulmonary artery pressure–to–pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension
Section snippets
Data source
UNOS provided Standard Transplant Analysis and Research (STAR) files with donor-specific data from December 1988 to June 2011. The data set included prospectively collected metrics from all patients who underwent thoracic transplantation in the United States. The current study was granted an exemption by the Johns Hopkins Institutional Review Board because none of the investigators had access to data sets containing protected health information.
Study design
We retrospectively examined all primary, adult
Cohort statistics
From December 1988 to June 2011, 43,494 patients aged > 17 years underwent primary OHT. After excluding 18,041 patients without complete hemodynamic data and 8,642 patients without PH (mPAP < 25 mm Hg), the final study cohort consisted of 16,811 patients.
ROC curve analyses
When considering all patients with PH (mPAP ≥ 25 mm Hg), DPG, TPG, and PVR all had poor ability to discriminate survivors from non-survivors, as evidenced by the AUC values near 0.5 (Table 1). The optimal cut points for DPG in those patients
PH with an elevated TPG and elevated PVR
In 4,419 patients with a TPG > 12 mm Hg and PVR > 3 WU and in 1,290 with a TPG > 15 mm Hg and PVR > 5 WU, there was no difference in survival between low and high DPG groups at up to 5 years post-OHT (Table 4).
Discussion
In OHT candidates with PH, determining the non-reversible component is vital for proper patient selection and good outcomes. Recent studies have suggested the dPAP-to-PCWP gradient may be useful in this regard,4, 6 but this has not been confirmed by large, multicenter studies. Using the UNOS database, we show that the DPG does not meaningfully delineate risk among patients with elevated TPG and PVR undergoing OHT.
An elevated TPG or PVR does not always reflect irreversible pulmonary vascular
Disclosure statement
This study received funding from the National Heart, Lung, and Blood Institute (Grants 1R01 HL114910-01 and L30 HL110304).
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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