predictor of poor outcome after transplant

 Q: Which of the following test predicts poor outcomes in patients undergoing heart-lung transplantation for idiopathic pulmonary hypertension (IPAH)? 

 A) High bilirubin 

 B) High LDH 

C) High hemoglobin 

D) High platelets 

 Answer: A

Pre-transplant high or persistent bilirubin level is found to be a good predictor of poor outcome in heart, lung, or heart-lung transplantation. This is probably due to high right atrial pressure causing hepatic congestion. Few suspected etiologies are valvular heart disease, ascites at transplant, and an old donor heart.

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References:

1. Kramer MR, Marshall SE, Tiroke A, Lewiston NJ, Starnes VA, Theodore J. Clinical significance of hyperbilirubinemia in patients with pulmonary hypertension undergoing heart-lung transplantation. J Heart Lung Transplant. 1991 Mar-Apr;10(2):317-21. PMID: 2031931.

2. Chokshi A, Cheema FH, Schaefle KJ, Jiang J, Collado E, Shahzad K, Khawaja T, Farr M, Takayama H, Naka Y, Mancini DM, Schulze PC. Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction. J Heart Lung Transplant. 2012 Jun;31(6):591-600. doi: 10.1016/j.healun.2012.02.008. Epub 2012 Mar 27. PMID: 22458996; PMCID: PMC3358427.