Frequency and Clinical Implications of Increased Pulmonary Artery Pressures in Liver Transplant Patients

Severe pulmonary hypertension in liver transplant candidates

“…This finding confirms reports that OLT can be undertaken safely in the presence of mild to moderate pulmonary hypertension. [1][2][3][4] However, severe pulmonary hypertension is associated with a much higher perioperative mortality rate. Two of 7 patients are alive with relatively good quality of life 5 and 2 years after OLT (patients 1 and 2, Table 3).…”

“…3 Pulmonary hypertension was then arbitrarily divided into three groups. Systolic pulmonary artery pressure of 30 to 44 mmHg was classified as mild, 45 to 59 mmHg as moderate, and 60 mmHg and greater as severe pulmonary hypertension.…”

“…Mild to moderate pulmonary hypertension has not been reported to contribute to mortality after transplant or to influence the clinical outcome. [1][2][3] On the other hand, severe primary pulmonary hypertension carries a significant perioperative risk and in many cases limits the quality of postoperative survival. 4 All records of OLT patients with severe pulmonary hypertension were studied in detail in an attempt to establish criteria for likely success of OLT in these patients.…”

Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation

“…1-7 Between 30% to 70% of the patients with cirrhosis are reportedly hypoxemic; 0.25% to 12.5% of the patients with advanced liver disease have clinical evidence of pulmonary hypertension, with higher percentages reported in studies using right cardiac catheterization. 1,4,[6][7][8][9][10] The natural history of this association between portal hypertension and pulmonary dysfunction in patients with cirrhosis, possible mechanisms, and implications for liver transplantation are not well understood.The histomorphological and morphometric features of pulmonary vascular lesions in this population, particularly venous lesions, have not been extensively studied. 7,[11][12][13] In addition, few attempts have been made to correlate pulmonary morphological changes with clinical evidence of pretransplantation pulmonary dysfunction.…”

“…These pathological pulmonary conditions in patients with cirrhosis have been well documented in the absence of other intrinsic cardiac and pulmonary diseases. [1][2][3][4][5][6][7] Between 30% to 70% of the patients with cirrhosis are reportedly hypoxemic; 0.25% to 12.5% of the patients with advanced liver disease have clinical evidence of pulmonary hypertension, with higher percentages reported in studies using right cardiac catheterization. 1,4,[6][7][8][9][10] The natural history of this association between portal hypertension and pulmonary dysfunction in patients with cirrhosis, possible mechanisms, and implications for liver transplantation are not well understood.…”