Preoperative 2D-echocardiographic assessment of pulmonary arterial pressure in subgroups of liver transplantation recipients

• Published in: Anesthesia and pain medicine (Korean society of anesthesiologists) Vol. 16; no. 4; pp. 344 - 352
• Main Authors: Park, Jungchan, Park, Myung Soo, Kwon, Ji-Hye, Oh, Ah Ran, Lee, Seung-Hwa, Choi, Gyu-Seong, Kim, Jong Man, Kim, Keoungah, Kim, Gaab Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Anesthesiologists 01.10.2021; 대한마취통증의학회
• Subjects: catheterization; echocardiography; hypertension; liver transplantation; pulmonary; swan-ganz; Transplantation Anesthesia; 마취과학; Hypertension; Echocardiography; Catheterization; Swan-ganz; Pulmonary; Liver transplantation
• ISSN: 1975-5171; 2383-7977; 2383-7977
• DOI: 10.17085/apm.21028

Background: The clinical efficacy of preoperative 2D-echocardiographic assessment of pulmonary arterial pressure (PAP) has not been evaluated fully in liver transplantation (LT) recipients.Methods: From October 2010 to February 2017, a total of 344 LT recipients who underwent preoperative 2D-echocardiography and intraoperative right heart catheterization (RHC) was enrolled and stratified according to etiology, disease progression, and clinical setting. The correlation of right ventricular systolic pressure (RVSP) on preoperative 2D-echocardiography with mean and systolic PAP on intraoperative RHC was evaluated, and the predictive value of RVSP > 50 mmHg to identify mean PAP > 35 mmHg was estimated.Results: In the overall population, significant but weak correlations were observed (R = 0.27; P < 0.001 for systolic PAP, R = 0.24; P < 0.001 for mean PAP). The positive and negative predictive values of RVSP > 50 mmHg identifying mean PAP > 35 mmHg were 37.5% and 49.9%, respectively. In the subgroup analyses, correlations were not significant in recipients of deceased donor type LT (R = 0.129; P = 0.224 for systolic PAP, R = 0.163; P = 0.126 for mean PAP) or in recipients with poorly controlled ascites (R = 0.215; P = 0.072 for systolic PAP, R = 0.21; P = 0.079 for mean PAP). Conclusion: In LT recipients, the correlation between RVSP on preoperative 2D-echocardiography and PAP on intraoperative RHC was weak; thus, preoperative 2D-echocardiography might not be the optimal tool for predicting intraoperative PAP. In LT candidates at risk of pulmonary hypertension, RHC should be considered.