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Minerva Medica 2014 February;105(1 Suppl 1):1-7


language: English

Pulmonary hypertension in COPD and lung transplantation: timing and procedures

Solidoro P. 1, Boffini M. 2, Lacedonia D. 3, Scichilone N. 4, Paciocco G. 5, Di Marco F. 6

1 Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Cittá della Salute e della Scienza, Turin, Italy; 2 Cardiac Surgery Division, Surgical Sciences Department, University of Turin, Città della Salute e della Scienza, Turin, Italy; 3 Sezione di Malattie dell’ Apparato Respiratorio, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Foggia, Foggia, Italia; 4 DIBIMIS, Università degli Studi di Palermo, Palermo, Italy; 5 Department of Cardio‑Thoracic and Vascular Surgery, Unit of Pneumology, Università degli Studi di Milano‑Bicocca, San Gerardo Hospital, Monza, Italy; 6 Pneumology, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy


The prevalence of pulmonary hypertension (PH) in the general chronic obstructive pulmonary disease (COPD) population is undefined because stable COPD patients do not routinely undergo screening echocardiogram and right heart catheterization. Most studies published on this topic are focused on a highly selected group of patients with moderate to severe disease awaiting lung transplantation, since hemodynamic data from cardiac catheterization are part of the standard transplant evaluation. In a very recent article, Hurdman et al. studied the characteristics and outcomes, with a particular focus on mortality, of extensively phenotyped, consecutive patients with PH-COPD over a 9-year period. This article offers the opportunity to update the role of PH in COPD as a timer to propose lung transplantation, based on solid literature data on survival, and to select the best procedure (single or double lung transplant), since the outcome indexes based on the old GOLD classification according to FEV1 (1-4) and the new GOLD classification (A-D) have failed in purpose to define the correct timing, due to the lack of functional (6 minutes walking test) and nutritional (Body Mass Index) data. After a revision of available literature including the recent paper of Hurdman et al. we conclude that the timing for lung transplantation is easy to manage in case of severe PH-COPD. On the other hand mild and moderate PH-COPD are still object of debate for therapy, procedure timing and choice and rehabilitation. In other words, we have some confirms for a little percentage of patients, whilst many doubts still exist for the rest.

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