Michael S. Miller, Shelsey W. Johnson, Alexander R. Opotowsky, Michael J. Landzberg, Nirmal S. Sharma, Hilary J. Goldberg, Alexandra K. Wong, Alison S. Witkin, Josanna Rodriguez-Lopez, Ronald H. Goldstein, Bradley A. Maron, Bradley M. Wertheim
Brigham and Women’s Hospital, Boston Children’s Hospital and Harvard Medical School. Veterans Affairs Boston Healthcare System. University of Cincinnati School of Medicine and Cincinnati Children’s Hospital Medical Center. Massachusetts General Hospital. Boston University School of Medicine. University of Maryland School of Medicine.
United States
Journal of Heart and Lung Transplantation Open
JHLT Open 2025;
DOI: 10.1016/j.jhlto.2024.100098
Abstract
Esophageal dysmotility is identified as a contraindication to lung transplantation at some centers due to increased risks of acute rejection, pulmonary infection, and chronic lung allograft dysfunction. Phosphodiesterase-type 5 inhibitors (PDE5i) are a cornerstone pharmacotherapy for pulmonary arterial hypertension (PAH) and are known to exert off-target effects that may impact lung transplant candidacy, including impaired esophageal contractility and decreased lower esophageal sphincter tone. We report 2 patients with PAH who were initially declined listing for lung transplantation due to iatrogenic esophageal dysmotility induced by PDE5is. Upon discontinuation of PDE5i therapy, these patients experienced significant improvement in esophageal motility within 14 days and met the criteria for transplant listing at their centers. Recognizing and mitigating the off-target effects of PDE5i medications is critical for maximizing access to transplant for patients with PAH.
Category
Lung Transplantation for Pulmonary Vascular Disease
Medical Therapy. Adverse Effects or Lack of Adverse Effects
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes