ABSTRACT
Although lung transplantation is a viable option for patients with end-stage pulmonary
hypertension, it is associated with numerous problems including infection, rejection,
and limited long-term survival. Because of these limitations, transplantation should
only be considered for patients who are failing maximal medical therapy. Treatment
options for patients with pulmonary hypertension that may serve to prolong or obviate
the need for transplantation include anticoagulation with warfarin, diuretics, and
vasodilators such as calcium channel blockers or continuous intravenous epoprostenol
(prostacyclin). The response to medical therapy should be assessed at regular intervals
by evaluating exercise tolerance and hemodynamic parameters. Because waiting periods
for transplantation now exceed 1.5 to 2 years in the United States, and the response
to medications is unpredictable, referral for transplantation should occur when patients
become symptomatic. Those who are responding well to medical therapy should be removed
from the active transplant waiting list, whereas those who fail therapy should go
on to transplant. Utilizing medical therapy and transplantation as complementary treatments
will achieve the best potential to improve quality of life and prolong survival.
KEYWORD
Lung transplantation - prostacyclin - pulmonary hypertension
