The Impact of Treatment of Portopulmonary Hypertension on Survival Following Liver Transplantation

• Published in: American journal of transplantation Vol. 7; no. 5; pp. 1258 - 1264
• Main Authors: Ashfaq, M., Chinnakotla, S., Rogers, L., Ausloos, K., Saadeh, S., Klintmalm, G. B., Ramsay, M., Davis, G. L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2007; Blackwell
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Blood Pressure - physiology; Bosentan; Diltiazem - therapeutic use; Epoprostenol - therapeutic use; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hypertension, Portal - complications; Hypertension, Portal - drug therapy; Hypertension, Portal - physiopathology; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - physiopathology; Liver Cirrhosis - complications; Liver Cirrhosis - physiopathology; Liver Cirrhosis - surgery; Liver transplantation; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pneumology; pulmonary hypertension; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Retrospective Studies; Sulfonamides - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Treatment Outcome; Vasodilator Agents - therapeutic use; Prognosis; Portal circulation disease; Digestive system; Respiratory disease; Liver; Cardiovascular disease; Transplantation; Homotransplantation; Survival; Pulmonary hypertension; Vascular disease; Treatment; Surgery; Portal hypertension; Digestive diseases; Graft; Portopulmonary hypertension; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01701.x

Pulmonary hypertension in the setting of cirrhosis and portal hypertension is known as portopulmonary hypertension (PPHTN). Moderate or severe PPHTN is uncommon, but has a poor prognosis and is considered to be a contraindication to liver transplantation. We assessed the impact of vasodilation therapy on pulmonary hemodynamics and outcome after liver transplant in these patients. Eighty‐six patients evaluated for liver transplant between 1997 and 2005 had an estimated right ventricular systolic pressure >40 mm Hg or a clinical suspicion of PPHTN. Right heart catheterization confirmed PPHTN in 30 patients (ten mild, eight moderate, and 12 severe). Sixteen of the 20 with moderate‐to‐severe pulmonary hypertension (mPAP ≥ 35) were otherwise considered suitable liver transplant candidates and were treated with vasodilation therapy. mPAP fell to less than 35 mm Hg in 12 patients (75%) and 11 of them then underwent orthotopic liver transplantation. One‐ and five‐year survivals in the transplanted patients were 91% and 67%, respectively. Nine of 11 were off vasodilator therapy after a median of 9.2 months following transplantation. None of the patients who failed vasodilator therapy survived (median survival, 8 months). Effective pharmacologic control of PPHTN before liver transplant is associated with excellent posttransplant survival that is similar to patients transplanted for other indications. Successful treatment of moderate and severe portopulmonary hypertension with vasodilator therapy is associated with improved survival after liver transplantation.