Predictor of successful transplant in PAH

Q: Which of the following lab can be used as a predictor of the success of organ transplant in pulmonary arterial hypertension (PAH) patients?

A) bilirubin

B) troponin

Answer: A

Bilateral lung or heart-lung transplantation is required for a patient with pulmonary hypertension if any of the following is suspected.

• World Health Organization (WHO) functional class III or IV during escalating therapy
• Rapidly progressive disease (before or on therapy)
• Use of parenteral prostanoid therapy regardless of functional class symptoms
• Known or suspected pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis

Elevated bilirubin is found to be correlated with postoperative mortality. Also, the likelihood of successful transplantation is poor if bilirubin does not come down post-transplantation.

#transplantation

#pulmonary

References:

1. Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015; 34:1.

2. Keogh AM, Mayer E, Benza RL, et al. Interventional and surgical modalities of treatment in pulmonary hypertension. J Am Coll Cardiol 2009; 54:S67.

3. Russo MJ, Davies RR, Hong KN, Iribarne A, Kawut S, Bacchetta M, D'Ovidio F, Arcasoy S, Sonett JR. Who is the high-risk recipient? Predicting mortality after lung transplantation using pretransplant risk factors. J Thorac Cardiovasc Surg. 2009 Nov;138(5):1234-1238.e1. doi: 10.1016/j.jtcvs.2009.07.036. PMID: 19837222; PMCID: PMC3073984.