A modified Delphi consensus was conducted by the Pulmonary Vascular Research Institute (PVRI) Lung Transplantation Workstream, involving 29 international experts on pulmonary arterial hypertension (PAH) and lung transplantation. The process generated consensus ( mean scores >_2.5 on Likert scale ) across 141 out of 223 statements relating to when to refer pulmonary arterial hypertension patients for transplantation, criteria for listing, and peri-operative management.
Key recommendations include initiating transplantation discussions early, even in “sick” candidates (including those with renal or hepatic impairment), and preferring bilateral lung transplantation for most pulmonary arterial hypertension patients. There was also consensus on bridging strategies (e.g. veno-arterial extra corporeal membrane oxygenation (ECMO), intraoperative invasive haemodynamic monitoring, and prolonged postoperative circulatory support tailored by echo and hemodynamics. These guidelines aim to standardise care and improve outcomes for pulmonary arterial hypertension patients undergoing lung transplant.
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Summary by Deger Kesimoglu, volunteer for the Alliance for Pulmonary Hypertension
Citation
Nicholas A. Kolaitis, Hayley Barnes, Deborah J. Levine, Howard Castillo, Selim M. Arcasoy, Matthew Bacchetta, Luke Benvenuto, Erika Berman-Rosenzweig, Marisa Cevasco, Caitlin T. Demarest, Celine Dewachter, Michiel E. Erasmus, Allan R. Glanville, John Granton, Shaf Keshavjee, Vikramjit Khangoora, Sheila Krishnan, Olaf Mercier, Andrea N. Miltiades, David Montani, Edward Murphy, Ivan Robbins, Franck F. Rahaghi, Sahar A. Saddoughi, Laurent Savale, Marc A. Simon, Jean-Luc Vachiery, Corey E. Ventetuolo, Helen M. Whitford, Reda E. Girgis, First published: 23 April 2025, PVRI, Volume15, Issue2, April 2025, https://doi.org/10.1002/pul2.70088