A65-18 A Better Bridge to Transplant: Inhaled Treprostinil Reduces Hospitalizations in PH-ILD

Rationale Development of pulmonary hypertension (PH) in patients with interstitial lung disease (ILD) is a relatively common complication, and is associated with increased morbidity, decreased pulmonary functional capacity, reduced quality of life, and more frequent hospitalizations. Frequent and often prolonged hospitalizations in patients with PH-ILD can delay or preclude candidacy for patients who are eligible for lung transplantation. Despite FDA approval of inhaled Treprostinil for PH-ILD in 2021, its use among transplant candidates remains limited by delayed diagnosis, fragmented care, and insurance barriers. This study evaluated whether initiating inhaled Treprostinil during the pre-transplant phase improves short-term outcomes and optimizes candidacy. Methods We conducted a single-centered, retrospective cohort study of 78 PH-ILD patients undergoing lung transplantation evaluation between April 2021 and April 2025. Patients were stratified by inhaled Treprostinil use. Demographics, comorbidities, hemodynamics, and pre-transplant outcomes were compared using t-tests and chi-square tests. Reasons for non-initiation of Treprostinil were identified by chart review. Results Our cohort included 23 patients (29%) who received inhaled Treprostinil. Majority of patients in the treatment group were female (69%) with average age of 56. The most common etiology of ILD was idiopathic pulmonary fibrosis (IPF) followed by autoimmune ILD in both treatment and non-treatment groups. Baseline characteristics of patients on Treprostinil appeared worse than non-Treprostinil group with lower diffusion capacity of carbon dioxide (DLCO) (3.14 mL/min/mmHg vs 9.37, p = 0.02), higher mean pulmonary arterial pressure (MPAP) (38.17 mmHg vs 34.94, p = 0.17) and higher pulmonary vascular resistance (PVR) (6.7 WU vs 6.38, p = 0.73). Despite more severe disease, patients on Treprostinil had statistically significant lower rates of all-cause hospital admissions (8 vs 34%, p = 0.029), suggesting that patients on appropriate PH treatment pre-transplant have better clinical outcomes. Some of the barriers for initiating Treprostinil in our patient population included lack of prescription despite consideration of therapy, insurance denials, inpatient evaluation with no outpatient follow-up, and inadequate time for treatment due to early transplantation. Conclusion Despite our small sample size, our study findings are consistent with current literature regarding improvement in clinical outcomes in patients with PH-ILD on inhaled Treprostinil. Despite their severe disease, we show less frequent hospitalization in this group which improves the likelihood of completing evaluation, maintaining clinical stability, and enlisting for lung transplantation. These findings support earlier initiation and prospective evaluation to confirm the impact on transplant outcomes. This abstract is funded by: None