Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease
Section snippets
Study population
This was a retrospective study of a randomly selected cohort of patients with COPD/emphysema and α-1-antitrypsin deficiency who underwent lung transplantation at the Copenhagen University Hospital, Rigshospitalet, Denmark, from January 1991 to January 2010. The main population has previously been extensively characterized.4 The lung transplant evaluation program for COPD at our institution includes right-heart catheterization (RHC). We analyzed the extent and severity of pulmonary vascular
Results
A total of 247 patients with COPD/emphysema or α-1-antitrypsin deficiency and a pulmonary capillary wedge pressure of≤15 mm Hg underwent lung transplantation (Figure 1). Of these patients, 154 (62.3%) had normal pulmonary pressures (non-PH) with mPAP<25 mm Hg, and 93 (37.7%) had PH characterized by mPAP≥25 mm Hg, of whom 83 had mild–moderate PH (mPAP 25–34 mm Hg), and 10 had severe PH (mPAP≥35 mm Hg).
Thirty patients were randomly selected from the 154 non-PH patients. Similarly, 30 patients
Discussion
The present study identified pulmonary vascular changes as an important component of COPD-related PH. Structural changes were observed prevalent at all stages of the disease and correlated with the degree of PH. In a small sub-set of patients with severe PH, in whom pulmonary pressures approached those characteristic of IPAH, vascular lesions were observed and included plexiform lesions, pulmonary hemosiderosis, and angiomatoid lesions.
Disclosure statement
This study received support from the Jacob & Olga Madsens Foundation and the Heart-Center Research Foundation.
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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2020, ChestCitation Excerpt :We demonstrate that Dlco is correlated moderately with PVR, which suggests that a component of what Dlco is capturing in this population is related to morphologic changes to the pulmonary vasculature. Prior histologic studies of explanted lungs from patients with end-stage COPD identified increased pathologic lesions in the pulmonary vessels, including decreased pulmonary capillary density, with increasing PH severity.45-47 Reduction in capillary density represents a plausible pathophysiologic correlate for reduction in Dlco and generates hypotheses that Dlco may be sensitive to early pulmonary vascular disease.