Initial experience with bosentan for the management of pulmonary hypertension after heart transplantation

Background Pulmonary hypertension ( PH ) after heart transplantation ( HT ) is associated to right ventricular ( RV ) dysfunction and increased morbidity and mortality. We present our experience with bosentan for the treatment of PH after HT . Methods A retrospective evaluation of patients with PH receiving bosentan post‐transplant was performed. Pulmonary hemodynamics before and after bosentan ( BG ) and clinical outcomes were assessed and compared to a historical control group ( CG ) not receiving bosentan. Results Between 2013 and 2016, 21 patients were treated post‐transplant with bosentan. Twenty‐four hours after bosentan initiation, there were significant decreases in systolic (42.5 ± 8 to 38.1 ± 8 mm Hg, P  = 0.015), diastolic (21.4 ± 4 to 17.8 ± 6 mm Hg, P  = 0.008) and mean (29.6 ± 5 to 25 ± 6 mm Hg, P  = 0.001) pulmonary artery pressures ( PAP ), transpulmonary gradient (13.1 ± 3 to 9.7 ± 4 mm Hg, P  < 0.001), diastolic gradient (5.2 ± 4 to 2.3 ± 3 mm Hg, P  = 0.001) and pulmonary vascular resistance ( PVR ) (2.2 ± 1 to 1.6 ± 1 WU , P  = 0.015). This effect was maintained at day 3. Compared with CG , BG showed significantly more decrease in PVR (0.7 ± 0.9 vs 0.3 ± 1.7 WU , P  = 0.025) and mean PAP (4.6 ± 5.2 vs 1.5 ± 4.4 mm Hg, P  = 0.040). RV function 7 days post‐transplant was significantly better in BG compared to CG , P  = 0.004. There were not clinically significant interactions between bosentan and immunosuppressive treatment. Conclusions Bosentan, initiated early post‐transplant, was associated with a significant decrease in PVR . Bosentan was well tolerated and did not interact with immunosuppressive treatment.