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News
High pulmonary vascular resistance (PVR) alone shouldn't disqualify someone from a heart transplant, new research suggests. A large study found that it's actually the transpulmonary gradient (TPG) — not PVR — that predicts excess mortality after transplant. Clinicians are urged to stop reading PVR in isolation and consider both metrics together.
For decades, a high pulmonary vascular resistance (PVR) reading has been a common reason to turn away heart transplant candidates. But a new observational study is challenging that practice — and the findings could open the door for patients who've been unfairly ruled out.
Analyzing data from over 42,000 adult heart transplant recipients (2005–2025) in the Organ Procurement and Transplantation Network, researchers found that elevated PVR alone did not predict higher 1-year post-transplant mortality. Instead, it was a high transpulmonary gradient (TPG) — a direct, flow-independent measure of pressure drop across the lungs — that was significantly associated with excess mortality risk. The study was presented at the Heart Failure Society of America annual meeting and simultaneously published in JACC: Heart Failure.
The key insight: in low-output heart failure, reduced cardiac output can mathematically inflate PVR even when the lungs are actually fine, making PVR a potentially misleading standalone metric.
By the Numbers:
Why it matters: This research suggests some patients may be incorrectly excluded from life-saving transplants based on a single imperfect number. Incorporating TPG alongside PVR could lead to more accurate risk stratification and fairer access to heart transplantation.
