Long-term Prostacyclin Use Increases Risk of a Heart Problem After a Lung Transplant, Study Reports

Pulmonary hypertension patients who receive prostacyclin for a long time are at higher risk of developing cardiovascular complications after a lung transplant, a Japanese study reports.

The research, published in the International Heart Journal, was titled “High Frequency of Acute Adverse Cardiovascular Events After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Receiving Preoperative Long-Term Intravenous Prostacyclin.”

Prostacyclin, delivered intravenously, is a common treatment for patients with pulmonary arterial hypertension, or PAH. When drugs fail to help, doctors often recommend a lung transplant.

Only about half of patients who receive a lung transplant live for five years, however. Complications after surgery are a key reason for the low survival rate. Meanwhile, heart problems are one of the most frequent and major causes of death within 30 days of a lung transplant.

Previous studies have shown an increase in bleeding complications in patients who are on prostacyclin long term. This suggested that the drug could increase the risk of adverse events in those receiving lung transplants.

Researchers decided to investigate “the impact of length of intravenous prostacyclin therapy on acute adverse cardiovascular events, including hemorrhagic complication after lung transplantation.”

Their analysis covered 27 patients with PAH and one with peripheral pulmonary stenosis who had received lung transplants at Okayama University Hospital in Japan.

The team looked at adverse events in two groups within 30 days of a transplant. One group had received either no prostacyclin or treatment for only a short time — a median of seven months. The other group had received the therapy a median of three years and eight months.

Adverse events included bleeding in the chest; cardiac congestion or shock; a cerebral infarction, or a narrowing of blood vessels in the brain that is associated with stroke; a pulmonary embolism, or blood clot in the lungs; and death.

Four of the 22 adverse events occurred in the group that had never had prostacyclin or had received it for a short time. The other 18 occurred in the long-term treatment group.

The findings suggested that PAH patients who take prostacyclin for a long time are more likely to experience an acute heart problem after a lung transplant than those taking it for a short time.

“Physicians should consider the appropriate listing of lung transplantation, and surgeons need to be mindful of hemorrhagic complications in patients receiving preoperative long-term intravenous prostacyclin,” the team concluded.