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J Thorac Cardiovasc Surg 2009;138:222-226
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Right but not left ventricular function recovers early after living-donor lobar lung transplantation in patients with pulmonary arterial hypertension

^a Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
^b Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
^c Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
^d Department of Cardiovasuclar Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
^e Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

Received for publication May 8, 2008; revisions received August 8, 2008; accepted for publication February 22, 2009.

^_* Address for reprints: Hiroshi Date, MD, Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto 606-8507, Japan. (Email: hdate{at}kuhp.kyoto-u.ac.jp).

Objective: The aim of this study was to evaluate right and left ventricular functions in patients with pulmonary arterial hypertension after living-donor lobar lung transplantation compared with those without hypertension.

Methods: Thirty-three recipients of living-donor lobar lung transplantation were divided into two groups: those with pulmonary arterial hypertension (PAH group; n = 12) and those without (non-PAH group; n = 21). Their systolic pulmonary artery pressure was 93.1 ± 6.7 mm Hg versus 31.4 ± 2.9 mm Hg, respectively. Right and left ventricular ejection fractions, systolic pulmonary artery pressure, and cardiac index were serially measured by radionuclide ventriculography and right heart catheterization, respectively.

Results: Pretransplant right and left ventricular ejection fractions were lower in the PAH group (29.8% ± 7.0%, 49.9% ± 6.6%) than in the non-PAH group (49.7% ± 3.3%, 65.2% ± 1.9%) (P = .010, .068). Two months after living-donor lobar lung transplantation, right ventricular ejection fraction and systolic pulmonary artery pressure in the PAH group (57.3% ± 5.1%, 25.7 ± 1.8 mm Hg) improved dramatically, equal to those in the non-PAH group. In contrast, left ventricular ejection fraction and cardiac index in the PAH group (50.9% ± 3.7%, 2.66 ± 0.12 L · min^–1 · m^–2) were still significantly lower than in the non-PAH group (65.4% ± 2.8%, 3.13 ± 0.15 L · min^–1 · m^–2) (P = .0038, .037). At 6 to 12 months, the PAH group demonstrated a significant rise in left ventricular ejection fraction and cardiac index that reached similar values in the non-PAH group measured at 2 months. These values were stable for up to 3 years.

Conclusions: Right ventricular function recovered early after living-donor lobar lung transplantation in the PAH group. In contrast, recovery of left ventricular function required 6 to 12 months. Improved cardiac function was sustained for up to 3 years, suggesting long-term durability of cardiac function recovery after living-donor lobar lung transplantation.