Lung Transplantation With Elevated Pulmonary Vascular Resistance: Insights From the United Network for Organ Sharing Database.

Background: Pulmonary hypertension is a significant challenge in patients requiring a lung transplant, often being manifested with severe complications such as high pulmonary vascular resistance (PVR). Although medical treatments have extended median survival, pulmonary hypertension remains a progressive and life-threatening condition. Lung transplantation offers potential for improved outcomes, supported by advancements in surgical techniques, donor lung preservation, immunosuppression, and posttransplantation care. Methods: Using the United Network for Organ Sharing database, we analyzed adult patients undergoing double lung transplantation from October 1, 2002, to September 30, 2022. Our focus was on patients with elevated PVR (≥6 Wood units), with or without underlying lung parenchymal disease. Trends in transplantation, survival rates, and impact of center volume on outcomes were examined. Results: Of 24,921 double lung transplant recipients, 2755 patients had PVR ≥6 Wood units. There was a significant upward trend in annual procedures, with increased use of extracorporeal support during surgery. Higher volume centers (performing >33 transplants annually) demonstrated better survival rates. Elevated PVR was independently associated with higher mortality, highlighting its importance in patient selection and management. Conclusions: Lung transplantation remains a critical option for patients with end-stage lung disease, including those with high PVR. Improved outcomes at high-volume centers underscore the importance of institutional experience and expertise.