PVR Alone Should Not Rule Out Heart Transplant, Study Finds

A study presented at the Heart Failure Society of America annual meeting suggests that high pulmonary vascular resistance alone should not disqualify heart transplant candidates. Using Organ Procurement and Transplantation Network data, researchers found that an elevated transpulmonary gradient predicted excess one-year mortality, while high PVR by itself did not. The authors recommend interpreting PVR alongside TPG and clinical context rather than in isolation.

Researchers analyzed national transplant registry records and reported at the HFSA meeting, with simultaneous publication in JACC: Heart Failure. They grouped recipients by PVR and TPG levels. Excess one-year death risk appeared with high TPG regardless of PVR; high PVR with low TPG did not show a significant mortality link.

As continuous measures, higher TPG tracked with greater mortality, while higher PVR did not. The authors say high PVR with low TPG often reflects low cardiac output and high filling pressures, making the calculated resistance a flow-related artifact rather than fixed lung vascular disease. A commentator wanted absolute pulmonary pressure values before accepting the finding.