New strategy to resume and taper epoprostenol after lung transplant for pulmonary hypertension.

Akihiro Ohsumi, Akihiro Aoyama, Hideyuki Kinoshita, Tomoya Yoneda, Kazuhiro Yamazaki, Satona Tanaka, Daisuke Nakajima, Tadashi Ikeda, Kenji Minatoya, Hiroshi Date

General thoracic and cardiovascular surgery 2022 Apr

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The perioperative outcome of lung transplantation (LTx) for patients with severe pulmonary hypertension (PH) remains poor due to the occurrence of primary graft dysfunction (PGD) from left ventricular failure. We hypothesized that tapering pretransplant use of epoprostenol rather than abrupt discontinuation after transplantation might improve perioperative outcomes. We performed 23 LTxs for patients with severe PH who received epoprostenol therapy from 2008 until 2021. In the discontinued group (n = 6), epoprostenol was discontinued after the establishment of extracorporeal circulation. In the tapered group (n = 17), epoprostenol was discontinued and resumed after reperfusion, and then gradually tapered over the following 2 weeks. We assessed survival, bleeding, blood transfusion, re-opening of the chest, oxygenation, PGD score, extracorporeal membrane oxygenation (ECMO) requirement for recovery after transplantation, and duration of mechanical ventilation. The PGD score was significantly lower in the tapered group than in the discontinued group at 0 h, 24 h, and 48 h after LTx. In addition, the discontinued group required longer mechanical ventilation than the tapered group. Delayed chest closure and post-transplant ECMO use for recovery occurred significantly more frequently in the discontinued group. To resume and taper epoprostenol administration after reperfusion in patients with severe PH may be a valuable new strategy associated with better perioperative outcomes. © 2021. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.

Citation

Akihiro Ohsumi, Akihiro Aoyama, Hideyuki Kinoshita, Tomoya Yoneda, Kazuhiro Yamazaki, Satona Tanaka, Daisuke Nakajima, Tadashi Ikeda, Kenji Minatoya, Hiroshi Date. New strategy to resume and taper epoprostenol after lung transplant for pulmonary hypertension. General thoracic and cardiovascular surgery. 2022 Apr;70(4):372-377