Redefining
the Window of Opportunity in Lung Transplantation
Our articles in this issue span the
spectrum of treatment for severe pulmonary hypertension
(PH), not only from a historical perspective through
our profiling of the work of Joel Cooper, MD, a true
pioneer in the surgical suite, but also in terms of
the therapeutic options available, from medical therapy
to lung transplantation. The discussion is particularly
timely and relevant because the allocation system
for donated lungs may soon be changed by the United
Network of Organ Sharing.
Although the options for managing
patients with right ventricular failure have expanded
significantly through the use of prostanoids and with
atrial septostomy, the paramount issue remains in
those patients whose disease is no longer adequately
responding to these measures: When is it the right
time to proceed with transplantation or listing?
Our experts on the Pulmonary Hypertension
Roundtable addressed a multitude of issues surrounding
this question. Although outcomes have improved in
the 20 years that lung transplantation has been available
for PH, the observation of Dr Cooper—that this surgery
remains among the most demanding and difficult largely
because of postoperative considerations—remains true.
Outcomes in general for lung transplantation for PH
have been inferior to those for many other diseases,
such as chronic obstructive pulmonary disease.
Because of strides made in medical
management, however, we have been able to extend the
window prior to lung transplantation in many patients.
Ironically, this sometimes has proved to be a mixed
blessing. The advent of continuous intravenous epoprostenol,
a medication that has revolutionized the treatment
of pulmonary arterial hypertension, thereby offering
the potential to delay transplantation, may have resulted
in a higher proportion of extremely sick, higher-risk
patients presenting for transplantation.
The articles in this issue offer a
comprehensive resource to address these questions
as they delineate the practices and policies prevailing
at centers of excellence throughout the country. Once
again, I wish to congratulate my colleagues who contributed
to this issue on a job well done.
Editor-in-Chief Richard Channick, MD
Professor of Clinical Medicine
Pulmonary and Critical Care Division
University of California, San Diego Medical Center
San Diego, California
Immediate Past Editor Ronald J. Oudiz, MD
Associate Professor of Medicine
The David Geffen School of Medicine at UCLA
Director, Liu Center for Pulmonary Hypertension
LA Biomedical Research Institute at Harbor-UCLA Medical Center
Editor-in-Chief Elect Erika Berman Rosenzweig, MD
Director, Pulmonary
Hypertension Center, Columbia University Medical Center Associate
Professor of Clinical Pediatrics (in Medicine)
Associate Editors
Kristin Highland, MD
Assistant Professor of Medicine
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
Medical University Of Carolina
Francisco Soto, MD, MS
Director, Pulmonary Hypertension Program
Pulmonary and Critical Care Medicine
Medical College of Wisconsin
Todd Bull, MD
Associate Professor of Medicine
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Health Sciences Center
Robert Schilz, DO, PhD
Medical Director of Lung
Transplantation and Pulmonary Vascular Disease
University Hospital of Cleveland
Case Western Reserve University
Cleveland, Ohio
Publisher
Pulmonary Hypertension Association
Carl Hicks, Board Chair
Rino Aldrighetti, President
Sherrie Borden, Vice President, Medical and Patient Education
Publishing Staff Managing Editor
Deborah L. McBride
McBride Strategic Services
mcbridedeb@aol.com
P: 773-348-5455
C: 312-307-5455
Design Director
Michael McClain
Advances in Pulmonary Hypertension is circulated to
cardiologists, pulmonologists, rheumatologists and other selected
physicians by the Pulmonary Hypertension Association. The contents of the articles are independently determined by the Editor
and the Editorial Advisory Board.
Editorial Mission Advances in Pulmonary Hypertension is committed
to help physicians in their clinical decision
making by informing them of important
trends affecting their practice. Analyzing the
impact of new findings and covering current
information in the peer-reviewed literature,
Advances in Pulmonary Hypertension is published
four times a year. Advances in Pulmonary
Hypertension is the official journal
of the Pulmonary Hypertension Association.
Each article in this journal has been reviewed
and approved by members of the Editorial
Advisory Board.
Editorial Board
Charles Burger, MD
Medical Director, PH Clinic
Mayo Clinic
Jacksonville, FL
Karen Fagan, M.D. Chief, Division of Pulmonary and Critical Care Medicine University of South Alabama
Eli Gabbay, MD
Lung Transplant Unit
Royal Perth Hospital
Nick Kim, M.D.
Associate Clinical Professor of Medicine
University of California San Diego
Deborah Jo Levine, M.D.
University of Texas Health Science Center at San Antonio
San Antonio, TX
Omar Minai, MD
Dept of Pulmonary, Allergy and Critical Care Medicine
Myung Park, MD
Associate Professor of Medicine
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Health Sciences Center
Fernando Torres, MD Director Pulmonary Hypertension Clinic
UTSW Medical Center Dallas
University Hospital
Glenna Traiger, RN, MSN
Pulmonary & Critical Care
Pulmonary Hypertension CNS
University of California Los Angeles
Los Angeles, CA
R. James White, MD, PhD
Assistant Professor of Medicine, Pharmacology & Physiology
University of Rochester, Division of Pulmonary and CCM
Roham Zamanian, MD
Division of Pulmonary and Critical Care Medicine
Stanford University Medical Center
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Redefining
the Window of Opportunity in Lung Transplantation
