B106-04 Single Lung Transplant for Patients With Pulmonary Fibrosis and Severe Pulmonary Hypertension- Should the Severity of Pulmonary Hypertension Dictate the Terms?

Abstract Background Single lung transplant has been proposed as a viable option for patients with severe WHO group 3 pulmonary arterial hypertension due to pulmonary fibrosis. Most studies have yielded variable results and were done prior to the new ERS/ESC definition of severe pulmonary hypertension (PH). Herein, we study the survival difference between single lung transplant patients when stratified by the severity of PH. Methods We conducted a retrospective cohort study of lung transplant patients at Temple University Hospital between January 2015 and January 2025. All patients had right heart catheterization (RHC) done prior to lung transplant. Severe PH was defined as Pulmonary Vascular Resistance (PVR) 5. All patients with WHO group 1 or 2 PH were excluded. Kaplan-Meier survival analysis was performed and compared between the two groups. Results A total of 238 patients were included in the final analysis. Most patients (82%, n = 197) had non-severe PH, while 41 patients (18%) had severe PH. Most patients (71%, n = 170) had Idiopathic Pulmonary Fibrosis (IPF), followed by HP-ILD and Combined Pulmonary Fibrosis and Emphysema (CPFE) with predominant fibrosis (n = 20 and 10%). All patients in severe PH group had a mean PVR of 6.90±1.8, with a mean systolic PAP of 57.9±13.6, a mean PAP of 39.5±8.7, and a mean PCWP of 8.5±4.0. During the first two years, survival rates were similar between the severe and non-severe pulmonary hypertension (PH) groups (87% vs. 88% in the first year, and 75% vs. 79% in the second year). However, by the third year, survival declined more noticeably in the severe PH group (50% vs. 67%). Kaplan Meier survival analysis showed similar short-term survival (up to 2 years) but markedly lower long-term survival for the severe PH group. (Figure 1) Conclusion Patients with severe WHO group 3 PAH due to pulmonary fibrosis have a similar 2-year survival to those with non-severe PH after a single lung transplant. However, their survival declines significantly after 2 years which warrants further investigation. This abstract is funded by: None