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Introduction Post COVID interstitial lung disease (ILD) can occur following COVID-19 (Myall et al, 2021). The prevalence of pulmonary hypertension (PH) due to post-COVID ILD in a US cohort referred for lung transplantation was 27% (Thomas et al, 2023); this has not been reported in the UK. We describe consecutive patients with right-heart catheterisation (RHC)-confirmed PH due to post-COVID ILD, referred from a large area to the Royal Brompton PH Service from 2020–2025.Methods PH was defined at RHC as mPAP>20 mmHg and a PVR>2 Wood units (WU). Clinical details were recorded at PH diagnosis and first follow-up (3–6 months). Other causes of ILD including CTD-ILD were excluded. Data are mean+-SD and median (IQ range) unless specified. Registry ethics was approved (RSID 195474).Results Patients (n=10) were male (n=6), age 62 +-10 y at PH diagnosis, ex-smokers (n=5), mostly WHO III (n=8), 6MW 137 (60–202) m. Patients were diagnosed with ILD-PH at median 2.4 (1.1–4.4) years after their initial COVID illness. All had undergone invasive ventilation on ICU for 8 (6–24) weeks, one (who later died) needed ECMO. None had pre-existing lung disease.BNP was median (range) 99 (65–539) ng/L. RAP was 4 (3–11) mmHg, mPAP 34+-11 mmHg, PCWP 9.4 +- 6 mmHg, CO 3.8 (2.7–4.5) l/min and PVR 7.0 (4.7–10.7) WU. FVC was 78 (54–87)%, TLCO 33 (23–46)%, KCO 55 (45–57)% predicted. PVR was over 5 WU in 7 (78%). CT patterns included organising pneumonia, with elevated PA:aortic ratio at 1.07 +- 0.19 and RV:LV ratio in all subjects at 1.2+-0.08 (figure 1A-D).Following ILD-PH diagnosis, 4 patients were treated with sildenafil. At median follow up 1.5 (0.4–2.5) years from PH diagnosis, there have been 2/10 deaths and no lung transplantations so far.Abstract P283 Figure 1Conclusion Post Covid-ILD-PH was only seen in patients after prolonged invasive mechanical ventilation and is likely to be a rare complication of COVID-19. All patients had elevated BNP, and RV:LV and/or PA:aortic ratio on unenhanced CT scans: these non-invasive screening markers should prompt referral for echocardiography and onwards to PH centres.