Despite the progress made in medical therapies for treating pulmonary hypertension (PH), a subset of patients remain susceptible to developing a maladaptive right ventricular phenotype. The effective management of end-stage PH presents substantial challenges, necessitating a multidisciplinary approach and early identification of patients prone to acute decompensation. Identifying potential transplant candidates and assessing the feasibility of such a procedure are pivotal tasks that should be undertaken early in the treatment algorithm. Inclusion on the transplant list is contingent upon a comprehensive risk assessment, also considering the specific type of PH and various factors affecting waiting times, all of which should inform the decision-making process. While bilateral lung transplantation is the preferred option, it demands expert intra- and post-operative management to mitigate the heightened risks of pulmonary oedema and primary graft dysfunction in PH patients. Despite the availability of risk assessment tools, the occurrence of acute PH decompensation episodes can be unpredictable, potentially leading to refractory right ventricular failure even with optimal medical intervention, necessitating the use of rescue therapies. Advancements in right ventricular assist techniques and adjustments to graft allocation protocols for the most critically ill patients have significantly enhanced the survival in intensive care, affording the opportunity to endure while awaiting an urgent transplant. Given the breadth of therapeutic options available, specialised centres capable of delivering comprehensive care have become indispensable for optimising patient outcomes. These centres are instrumental in providing holistic support and management tailored to the complex needs of PH patients, ultimately enhancing their chances of a successful transplant and improved long-term prognosis.

尽管治疗肺动脉高压 （PH） 的药物治疗取得了进展，但仍有一部分患者容易出现适应不良的右心室表型。终末期 PH 的有效管理带来了巨大的挑战，需要多学科方法和早期识别容易出现急性失代偿的患者。确定潜在的移植候选者并评估此类手术的可行性是应在治疗流程早期进行的关键任务。是否被列入移植名单取决于全面的风险评估，还考虑了 PH 的具体类型和影响等待时间的各种因素，所有这些都应为决策过程提供信息。虽然双侧肺移植是首选方案，但它需要专业的术中和术后管理，以减轻 PH 患者肺水肿和原发性移植物功能障碍的风险增加。尽管有风险评估工具，但急性 PH 失代偿发作的发生可能是不可预测的，即使进行最佳医疗干预，也可能导致难治性右心室衰竭，因此需要使用抢救疗法。右心室辅助技术的进步和对最危重患者的移植物分配方案的调整显著提高了重症监护室的生存率，为等待紧急移植提供了忍耐的机会。鉴于可用的治疗选择的广泛性，能够提供全面护理的专业中心已成为优化患者预后不可或缺的一部分。 这些中心有助于根据 PH 患者的复杂需求提供全面的支持和管理，最终提高他们成功移植的机会并改善长期预后。