Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Heart-lung transplants (HLTx) is the only one effective strategy for advanced pulmonary arterial hypertension (PAH) with refractory right heart failure. But limited availability of combined organs (heart and lungs) leads to high mortality on the waiting list. Parenteral prostacyclin is usually recommended in severe PAH therapy. The study is aimed to determine the efficacy of treprostinil as a bridge to HLTx in eligible candidates.
*Methods: Retrospective, cohort study of 24 patients with end-stage PAH referred for HLTx to our centre between 2015 Jan to 2018 Oct. All of the patients were combined with sildenafil and bosentan. The patients were divided into 2 groups according to whether they were treated with subcutaneous treprostinil (ST) on the waiting list. 11 patients were divided into ST group and the other 13 into controls. The primary endpoint was the mortality on the waiting list for HLTx. Meanwhile, right heart catheterization, six minutes walking distance (6MWD), and NT-proBNP were performed before ST initiation and near HLTx.
*Results: The initial ST dose was 1.25 ng/kg/min, and increased to 28 ng/kg/min step by step over 30-60 days. The maximal dosage of ST was 18.1±3.8 ng/kg/min, on average. Six (46.1%) patients were died before HLTx in control group. Two (18,2%) patients were died in ST group, but one died of sepsis. In addition, ST group presented a significant improvement in hemodynamics including mean pulmonary artery pressure (75.82±29.64 to 56.73±15.99 mmHg), right atrial pressure (11.82±3.06 to 8.73±1.79 mmHg) and cardiac index (2.24±0.59 to 2.55±0.66 L/min/m2). 6MWD had increased from 245±70 to 363±45 m, and NT-proBNP decreased from 5154±2231 to 3381±1479 pg/mL, with each P<0.01.
*Conclusions: The data suggest that bridging with ST can decrease the mortality significantly on the waiting list, slowing the progression of PAH by improving right heart hemodynamics and function.
To cite this abstract in AMA style:Ju C, Lian Q, Wei B, Xu X, He J, Chen R. Treprostinil as a Bridge Therapy to Heart-Lung Transplants with Severe Pulmonary Arterial Hypertension [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/treprostinil-as-a-bridge-therapy-to-heart-lung-transplants-with-severe-pulmonary-arterial-hypertension/. Accessed April 4, 2020.
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