232: Treatment of Pulmonary Hypertension Secondary to Left Heart Insufficiency with a Dual Endothelin Receptor Antagonist (Bosentan®) in Patients Awaiting Heart Transplantation

The Journal of Heart and Lung Transplantation Volume 28, Number 2S

Abstracts

BMI ⱖ26, and RVSP ⱖ30 mmHg by multivariate analysis. Patients with PH had lower six minute walk distance (285.5⫾122 meters vs. 343⫾213 meters) and survival rates at 1, 4, and 8 years of 93%, 75%, and 43% compared to those of patients without PH (100%, 90%, and 76%). Patients with severe PH (N⫽27; 33%) had more nocturnal desaturation (p⫽0.045), worse pulmonary hemodynamics, and higher mortality (37%) than groups with mild/moderate PH (16%) or without PH (16%). Conclusions: Our study shows that both pre-capillary and postcapillary PH may occur in association with OSA. Though generally mild to moderate, severe PH may also occur. Female gender, younger age, obesity, and nocturnal desaturation were associated with PH. Pulmonary hypertension may be the cause of functional limitation and increased mortality in patients with OSA. 231 Twenty Years Experience of Heart Lung Transplantation for Pulmonary Vascular Disease L.A. Tanner2, N.J. Green2, G. Parry2, A. Hasan2, J.H. Dark1,2, P.A. Corris1,2 1Newcastle University, Newcastle upon Tyne, United Kingdom; 2Freeman Hospital, Newcastle upon Tyne, United Kingdom Purpose: We describe the long term results of Heart Lung Transplantation (HLT) for patients with pulmonary vascular disease (idiopathic pulmonary arterial hypertension(IPH)/ chronic thromboembolic (CTEPH) and pulmonary hypertension secondary to congenital heart disease (CHD)), including survival and morbidity. Results are compared with the registry data from ISHLT. Methods and Materials: All patients who underwent heart-lung transplantation during the period 1988-2008 were identified using the transplant database. Data on survival, BOS, renal function and the presence of hypertension and diabetes was obtained retrospectively from case records. Data was analysed as a combined group and independently for PAH and CHD. Results: A total of 57 patients underwent HLT for pulmonary vascular disease. There were 41 female and 16 male patients. The median age was 32.7 yr (range 7-60.4). 25 of the 57 patients were transplanted for PAH (23 IPH, 2 CTEPH) and 32 for CHD. Overall half-life survival post heart-lung transplant ⫽ 5.86 years. CHD half-life survival ⫽ 5.95 years (ISHLT registry 5.8). PAH half-life survival ⫽ 5 years (ISHLT registry 4.3). There was no significant difference in survival outcomes between the two groups (p⫽NS). BOS free survival was significantly greater in the CHD compared with PAH group (p ⫽ 0.0298). Overall 11% (6/57) of recipients developed diabetes and 40% (23/57) hypertension post transplant. Creatinine rose from mean 97 ⫹/- SD 29.47 micromol/L pre-transplant to 132 ⫹/- 39.57 in survivors at year 5. 1 patient underwent renal transplantation and 1 patient was commenced on haemodialysis. Conclusions: We have demonstrated improved survival compared to ISHLT data in both CHD and PAH. No significant difference in survival was demonstrated between the two groups. In this centre we report a significant difference in the BOS free survival in CHD compared to PAH. Survival HLT Survival

30 days

1yr

3yr

5yr

10yr

CHD PAH

88% 90%

72% 77%

72% 75%

59% 57%

42% 35%

Freedom from BOS % Free from BOS CHD PAH

1yr 94% 84%

3yr 78% 49%

5yr 70% 40%

10yr 57% 29%

S147

232 Treatment of Pulmonary Hypertension Secondary to Left Heart Insufficiency with a Dual Endothelin Receptor Antagonist (Bosentan®) in Patients Awaiting Heart Transplantation U. Schulz, G. Tenderich, S. Schulte-Eistrup, R. Koerfer Heart and Diabetes Center NRW, Bad Oeynhausen, NRW, Germany Purpose: Heart failure (HF) may be complicated by pulmonary hypertension (PH). The oral dual endothelin receptor antagonist bosentan may be beneficial in patients with HF and severe PH. We investigated the effects of bosentan in a patient group awaiting heart transplantation. Methods and Materials: In an open-label, observational study at the Heart and Diabetes centre NRW, Germany 63 patients with stable, moderate-to-severe HF and pulmonary vascular resistance (PVR) ⬎3 WE or transpulmonary gradient (TPG) ⬎15 mmHg were enrolled and received bosentan 62.5 mg bid, rapidly up-titrated to 125 mg bid. Ten patients also received inhaled iloprost. Measurements included changes from baseline in right heart catheter measurements,NYHA class and hepatic enzymes. Results: Patients received bosentan for 8.08 ⫾ 6.90 months (range: 0.39 –36.46), generally well tolerated. The majority of patients improved (48.7%) or stabilized (29.7%) in NYHA classification. Significant improvements from baseline in cardiac index and PVR and decreases in TPG were observed. Table 1Eight patients were successfully bridged to heart transplant surgery. Conclusions: Bosentan may have beneficial treatment effects in patients with moderate-to-severe heart failure and PH. Bosentan treatment improved cardiopulmonary haemodynamics and NYHA classification, and was generally well tolerated. Change from baseline Parameter

Baseline (mean ⴞSD (n)

End of Bosentan therapy (mean ⴞSD (n)

P value

Cardiac Index (L/min/m2) SVR (dyn䡠s䡠cm–5) central venous pressure (mmHg) mPAP (mmHg) PCWP (mmHg) PVR (dyn䡠s䡠cm–5)

1,73 ⫾ 0,46 (48)

2,19 ⫾ 0.65 (37)

⬍0,001

1642,39 ⫾ 524,49 (44) 1294,46 ⫾ 461,26 (37) 0,002 14,59 ⫾ 6,89 (44) 10,68 ⫾ 4,95 (37) 0,005 44.70 ⫾ 13,66 (43) 28,19 ⫾ 7,89 (43) 460,40 ⫾ 323,78 (47)

37,50 ⫾ 14,25 (38) 22,40 ⫾ 9,07 (35) 309,00 ⫾ 243,19 (37)

0,023 0,004 0,017

233 Prevalence and Risk Factors of Non-Adherence after Lung Transplantation O.H. Bosma1, K.M. Vermeulen2, E.A. Verschuuren1, M.E. Erasmus3, W. Van der Bij1 1University Medical Centre Groningen, Groningen, Netherlands; 2University Medical Centre Groningen, Groningen, Netherlands; 3University Medical Centre Groningen, Groningen, Netherlands Purpose: To identify possible risk factors of non-adherence (NA) we studied adherence to immunosuppressive drugs in adult lung transplant recipients who were at least one year after transplantation. Methods and Materials: Between April 2007 and September 2008, intake and time of intake of tacrolimus was monitored in our centre using the Medication Event Monitoring System (MEMS®). Patients used the MEMS for a median of 95 days. NA was defined as Timing-adherence either ⬍ 90% or ⬍ 80%. Adherence was also scored by patients and their healthcare professionals. Karnofsky Performance Index, State-Trait Anxiety Inventory, Zung Self-rating Depres-