High-Risk Pulmonary Hypertension Does Not Worsen Outcomes in Heart Transplantation.

Pulmonary hypertension(PH) isarelativecontraindicationtohearttransplantation(HT). Multiple studiesshowedincreasedmortalityinpatientswithPH. Advancesincaremay have ledtoimprovedoutcomesinthemodernera. Weanalyzedpatientswhounderwent HT atourinstitutionbetween2014and2018. Wedividedpatientsinto2groupsbasedon the presenceofhigh-riskPHdefinedaseitherpulmonaryvascularresistance > 3 Wood units ortranspulmonarygradient > 15 mmHg. Theprimaryoutcomewassurvival. Secondary outcomeswerepost-HTmorbidityandchangesinhemodynamics. Subsequently, we analyzednationaltrendsofsingleorganHTrecipientswithahigh-riskPHbetween 1994 and2018fromtheUnitedNetworkforOrganSharingregistry. Of98patientswho underwent HTatourcenter, 32% hadPH. InpatientswithoutandwithPH, thesurvival was 100% at30days, 87%, and81% at3years(p= 0.96). Inbothgroups, pulmonaryvascular resistanceandtrans-pulmonarygradientdecreasedafterHT. Nationwidedata revealed 30-daysurvivalwithoutandwithPHat97% and98%(p= 0.47) and3-yearsurvival at86% and87%(p= 0.84), respectively, in2018. Theproportionofrecipientswith PH decreasedfrom25% in1994to19% in2018. RecipientsofHTwithandwithouthighrisk PHhadsimilarearlyandlatemortalityinasingle-centerandnationwideanalysis. PH improvedimmediatelyaftertransplant. TheUnitedNetworkforOrganSharingregistry analysisdemonstratescontinuedimprovementinsurvivalinpatientswithPHinthe modern era, whereastherelativepercentageofrecipientswithPHdecreasedovertime. (c) 2023 ElsevierInc. Allrightsreserved.(AmJCardiol2023;205:290-297)