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(822) - Right Ventricular Recovery After Lung Transplantation for Pulmonary Arterial Hypertension: : Impact of Immunosuppressive Regimen - Insights from the ScanCLAD Trial

Hjalmarsson, C ; Pentikainen, Markku O. ; Werther Evaldsson, Anna LU orcid ; Rådegran, Göran LU ; Magnusson, J. ; Kromann Lund, Thomas ; Raivio, Peter ; Leuckfeld, Inga ; Svahn, Johan LU and Dellgren, Göran (2026) ISHLT 2026: 46th Annual Meeting In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 45(5, Supplement). p.383-384
Abstract
Purpose: Right ventricular (RV) dysfunction is the key prognostic factor in pulmonary arterial hypertension (PAH). Progression to RV failure involves dilatation, systolic and diastolic impairment, fibrosis, and metabolic changes. Lung transplantation (LTx) normalizes RV afterload, but the extent of recovery and its relation to immunosuppressive therapy remain unclear. We aimed to assess RV function before and after LTx in patients with PAH in the multicenter ScanCLAD trial, describing echocardiographic parameters by immunosuppressive regimen (cyclosporine vs tacrolimus).
Methods: This subgroup analysis included PAH patients from the ScanCLAD trial (ClinicalTrials.gov NCT02936505). Transthoracic echocardiography was performed before and... (More)
Purpose: Right ventricular (RV) dysfunction is the key prognostic factor in pulmonary arterial hypertension (PAH). Progression to RV failure involves dilatation, systolic and diastolic impairment, fibrosis, and metabolic changes. Lung transplantation (LTx) normalizes RV afterload, but the extent of recovery and its relation to immunosuppressive therapy remain unclear. We aimed to assess RV function before and after LTx in patients with PAH in the multicenter ScanCLAD trial, describing echocardiographic parameters by immunosuppressive regimen (cyclosporine vs tacrolimus).
Methods: This subgroup analysis included PAH patients from the ScanCLAD trial (ClinicalTrials.gov NCT02936505). Transthoracic echocardiography was performed before and within 12 months after LTx. RV size and function were evaluated using standard and derived parameters (Table 1). Due to the small sample size, statistical testing was not performed; data are presented as mean ± SD or median [IQR].
Results: Of 249 ScanCLAD participants, 11 had PAH. Median time from LTx to follow-up was 3 [9] months. Both treatment groups showed marked RV improvement after LTx. Systolic pulmonary arterial pressure (sPAP) fell from 74 ± 6 to 24 ± 2 mmHg (cyclosporine) and from 80 ± 24 to 26 ± 5 mmHg (tacrolimus), indicating reduced RV afterload. Right atrial area and central venous pressure decreased, while RV performance indices improved. Fractional area change rose from 29 ± 11% to 44 ± 4% and from 18 ± 9% to 46 ± 8%, respectively while RV-PA coupling improved markedly in both groups. Cardiac output increased from 4.7 ± 0.2 to 5.7 ± 0.3 L/min and from 4.1 ± 1.2 to 6.2 ± 1.5 L/min.
Conclusion: Lung transplantation led to marked RV recovery in PAH patients, with similar improvements under cyclosporine and tacrolimus. Post-transplant recovery seemed largely regimen-independent, though tacrolimus reduced chronic lung allograft dysfunction incidence in the "parent study". (Less)
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
volume
45
issue
5, Supplement
pages
2 pages
publisher
Elsevier
conference name
ISHLT 2026: 46th Annual Meeting
conference location
Toronto, Canada
conference dates
2026-04-22 - 2026-04-25
ISSN
1557-3117
DOI
10.1016/j.healun.2026.02.833
language
English
LU publication?
yes
id
21d4f40b-e058-44f8-87c0-25cee494badf
date added to LUP
2026-07-02 08:51:52
date last changed
2026-07-02 10:01:22
@misc{21d4f40b-e058-44f8-87c0-25cee494badf,
  abstract     = {{Purpose: Right ventricular (RV) dysfunction is the key prognostic factor in pulmonary arterial hypertension (PAH). Progression to RV failure involves dilatation, systolic and diastolic impairment, fibrosis, and metabolic changes. Lung transplantation (LTx) normalizes RV afterload, but the extent of recovery and its relation to immunosuppressive therapy remain unclear. We aimed to assess RV function before and after LTx in patients with PAH in the multicenter ScanCLAD trial, describing echocardiographic parameters by immunosuppressive regimen (cyclosporine vs tacrolimus).<br/>Methods: This subgroup analysis included PAH patients from the ScanCLAD trial (ClinicalTrials.gov NCT02936505). Transthoracic echocardiography was performed before and within 12 months after LTx. RV size and function were evaluated using standard and derived parameters (Table 1). Due to the small sample size, statistical testing was not performed; data are presented as mean ± SD or median [IQR].<br/>Results: Of 249 ScanCLAD participants, 11 had PAH. Median time from LTx to follow-up was 3 [9] months. Both treatment groups showed marked RV improvement after LTx. Systolic pulmonary arterial pressure (sPAP) fell from 74 ± 6 to 24 ± 2 mmHg (cyclosporine) and from 80 ± 24 to 26 ± 5 mmHg (tacrolimus), indicating reduced RV afterload. Right atrial area and central venous pressure decreased, while RV performance indices improved. Fractional area change rose from 29 ± 11% to 44 ± 4% and from 18 ± 9% to 46 ± 8%, respectively while RV-PA coupling improved markedly in both groups. Cardiac output increased from 4.7 ± 0.2 to 5.7 ± 0.3 L/min and from 4.1 ± 1.2 to 6.2 ± 1.5 L/min.<br/>Conclusion: Lung transplantation led to marked RV recovery in PAH patients, with similar improvements under cyclosporine and tacrolimus. Post-transplant recovery seemed largely regimen-independent, though tacrolimus reduced chronic lung allograft dysfunction incidence in the "parent study".}},
  author       = {{Hjalmarsson, C and Pentikainen, Markku O. and Werther Evaldsson, Anna and Rådegran, Göran and Magnusson, J. and Kromann Lund, Thomas and Raivio, Peter and Leuckfeld, Inga and Svahn, Johan and Dellgren, Göran}},
  issn         = {{1557-3117}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  number       = {{5, Supplement}},
  pages        = {{383--384}},
  publisher    = {{Elsevier}},
  series       = {{The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation}},
  title        = {{(822) - Right Ventricular Recovery After Lung Transplantation for Pulmonary Arterial Hypertension: : Impact of Immunosuppressive Regimen - Insights from the ScanCLAD Trial}},
  url          = {{http://dx.doi.org/10.1016/j.healun.2026.02.833}},
  doi          = {{10.1016/j.healun.2026.02.833}},
  volume       = {{45}},
  year         = {{2026}},
}