Portopulmonary hypertension and the risk of high right ventricular systolic pressure in liver transplant candidates

• Published in: PloS one Vol. 17; no. 4; p. e0267125
• Main Authors: Hayashi, Ryoko, Kogiso, Tomomi, Kikuchi, Noriko, Yamamoto, Kana, Nakamura, Shinichi, Egawa, Hiroto, Hagiwara, Nobuhisa, Tokushige, Katsutoshi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.04.2022; Public Library of Science (PLoS)
• Subjects: Biochemistry; Biology and Life Sciences; Blood Pressure; Brain natriuretic peptide; Cardiac catheterization; Cardiology; Cholangitis; Cirrhosis; Complications and side effects; Diagnosis; Endoscopy; Esophagus; Female; Gastroenterology; Heart; Hepatitis; Humans; Hypertension; Hypertension, Portal - diagnosis; Hypertension, Pulmonary - etiology; Internal medicine; Intubation; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver diseases; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Male; Medical prognosis; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Parameters; Pathophysiology; Patients; Pulmonary Arterial Hypertension; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Regurgitation; Retrospective Studies; Survival; Systolic pressure; Transplantation; Transplants & implants; Vasodilators; Veins & arteries; Ventricle; Womens health; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267125

Portopulmonary hypertension (PoPH) is a rare and serious complication of liver cirrhosis and portal hypertension that can interfere with liver transplantation (LT). We evaluated the prevalence of PoPH and the clinical features of right ventricular systolic pressure (RVSP), which is equivalent to pulmonary artery systolic pressure, in LT candidates. This was a single-center retrospective study. A total of 157 Japanese patients with decompensated liver cirrhosis or portal hypertension (76 men, median age = 52 years [range: 18-68 years]) were enrolled. The relationships between RVSP and clinical parameters, and the prevalence of PoPH in LT candidates, were evaluated. The cardiological parameters were as follows: brain natriuretic peptide (BNP), 39.1 (4.0-780.5) pg/mL; RVSP, 31.2 (16.0-122.4) mmHg; ejection fraction, 58% (28-72%); and mean peak tricuspid regurgitation velocity, 2.3 (1.5-5.3) m/s. The RVSP was significantly higher in females (p = 0.02) and primary biliary cholangitis (PBC) patients (p = 0.01), and was weakly correlated with the BNP level (r = 0.40, p = 0.01). For RVSPs of < 36 and ≥ 36 mmHg, the 5-year survival rates were 36.1% versus 34.1%, and 85.4% versus 85.3%, in non-LT and LT cases, respectively (p = 0.47 and 0.69, respectively). Among six patients with an RVSP ≥ 50 mmHg, three (1.9%) were diagnosed with PoPH and treated with vasodilators. PoPH was observed in 3 cases (1.9%) in 157 LT candidates. In patients with suspected mild pulmonary hypertension (RVSP, 36 - 50 mmHg), LT was successfully performed.