Influence of Pulmonary Hypertension on Lung Transplant Survival and Graft Laterality in Interstitial Lung Disease

Authors

• Tomasz Stacel, Corewell Health West Fellow
• Cameron Lawson, Corewell Health West
• Magda Piekarska, Corewell Health West Fellow
• Isabelle Pokora, Corewell Health West
• Tomasz Timek, Corewell Health West
• Elizabeth Murphy, Corewell Health West
• Reda Girgis, Corewell Health West

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of Heart and Lung Transplantation

Abstract

Purpose: To compare hemodynamics, perioperative management, and survival in interstitial lung disease (ILD) recipients across pulmonary artery pressure (PAP) groups - No-Pulmonary Hypertension (PH) (< 20mmHg), moderate PH (20-35mmHg), and severe (≥35mmHg) to determine whether PH limits lung transplantation (LTx).   Methods: We retrospectively analyzed ILD recipients transplanted between 2012-2024 (n=237): Idiopathic Pulmonary Fibrosis (IPF, n=188), Pulmonary Fibrosis (PF, n=21) and Others (n=28). Pretransplant comorbidities were recorded. Groups were stratified by PAP (< 20, 20-35, ≥35mmHg). Hemodynamics, VA-ECMO use, Primary Graft Dysfunction Stage 3 (PGD3), Acute Kidney Injury (AKI) and Length of Stay were compared. Kaplan-Meier analysis assessed survival across groups and transplant types (bilateral vs. right- or left-sided single LTx).   Results: Progressive PH was accompanied by a significant rise in PVR and PCW with a parallel fall in cardiac index (CI) reflecting gradual right ventricular strain. Patients with higher PAP more often underwent BLT and required intraoperative VA-ECMO; however recovery including PGD3, postoperative ECMO, AKI and LoS remained comparable. Despite worse baseline characteristics including CHF in higher PAP, short- and long-term survival were statistically similar among three groups (log-rank p=0.28). Kaplan -Meier showed that right-SLT consistently outperformed left SLT. All data are summarized in Table 1.   Conclusion: Even severe PH did not worsen posttransplant survival when managed with tailored surgical and ECMO strategies. Recipients with PH achieved outcomes equivalent to those without PH, supporting transplant eligibility. In SLT, right sided grafts demonstrated better outcomes - likely reflecting both larger vascular and ventilatory capacity and should be favored whenever unilateral LTx is necessary.

Volume

45

Issue

5 Suppl

First Page

392

Last Page

393

Recommended Citation

Stacel T, Lawson C, Piekarska M, Pokora I, Timek T, Murphy E, et al. [Girgis R]. Influence of pulmonary hypertension on lung transplant survival and graft laterality in interstitial lung disease. J Heart Lung Transplant. 2026;45(5 Suppl):392-3. doi: 10.1016/j.healun.2026.02.851.

Comments

International Society for Heart and Lung Transplantation (ISHLT) 46th Annual Meeting and Scientific Sessions, April 22-26, 2026, Toronto, ON, Canada 

DOI

10.1016/j.healun.2026.02.851

ISSN

1053-2498