Moderate Primary Pulmonary Hypertension in Patients Undergoing Liver Transplantation

Taurà, Pilar; García‐Valdecasas, Juan Carlos; Beltrán, Joan; Izquierdo, E.; Navasa, Miquel; Sala-Blanch, J.; A, Mas; Balust, Jaume; Grande, L; Visa, Josep

doi:10.1213/00000539-199610000-00003

Cited by 78 publications

(19 citation statements)

References 17 publications

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“…If pulmonary hypertension is mild or moderate, it is often reversible after liver transplantation [75][76][77] and does not carry a higher mortality rate. 13,78 Severe pulmonary hypertension, on the other hand, increases the mortality rate after liver transplantation markedly. A PAP m between 35 and 50 mmHg causes an estimated 50% mortality, and this may increase to 100% if the PAP m exceeds 50 mmHg.…”

Section: Liver Transplantationmentioning

confidence: 99%

Portopulmonary hypertension

et al. 2006

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Portopulmonary hypertension (PPHT) is defined as precapillary pulmonary hypertension accompanied by hepatic disease or portal hypertension. Pulmonary hypertension results from excessive pulmonary vascular remodeling and vasoconstriction. These histological alterations have been indistinguishable from those of other forms of pulmonary arterial hypertension. Factors involved in the pathogenesis of PPHT include volume overload, hyperdynamic circulation, and circulating vasoactive mediators. The disorder has a substantial impact on survival and requires focused treatment. Liver transplantation in patients with moderate to severe PPHT is associated with a significantly reduced survival rate. The best medical treatment for patients with PPHT is controversial; most authors currently regard continuous intravenous application of prostacyclin as the treatment of choice for patients with severe PPHT. There is only very limited reported experience with inhaled prostacyclin or its analog, iloprost. Increasing evidence of the efficacy of the endothelin-receptor antagonist bosentan and of the phosphodiesterase-5 inhibitor sildenafil is emerging in highly selected patients with PPHT. In the future, a combination therapy of the above-mentioned agents might become a therapeutic option. Other agents such as beta-blockers seem to be harmful to patients with moderate to severe portopulmonary hypertension. Up-to-date, randomized, double-blind, controlled clinical trials are lacking and are needed urgently.

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Section: Liver Transplantationmentioning

confidence: 99%

Portopulmonary hypertension

et al. 2006

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“…It should be noted that NG infusion could improve function of other organs, first of all, of the lungs and heart. Liver reperfusion is often accompanied by damage to these organs [7,9]. The involvement of the L-arginine-NO system (e.g., NG) in the maintenance of the prooxidant-antioxidant balance is mediated by several mechanisms.…”

Section: Resultsmentioning

confidence: 99%

Effect of nitroglycerine on some parameters of the prooxidant-antioxidant balance and functional state of the liver during ischemia/reperfusion

Ходосовский¹,

Зинчук²

2006

Bull Exp Biol Med

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The effect of nitroglycerine on some parameters of the prooxidant-antioxidant balance and functional state of the liver under conditions of ischemia/reperfusion was studied on rabbits. Hepatic ischemia/reperfusion was accompanied by accumulation of LPO products, depletion of the antioxidant defense system, and increase in blood transaminase activity. Nitroglycerine infusion before the reperfusion period decreased the concentration of LPO products, increased activity of the antioxidant system, and improved liver function.

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“…Assuming up to 8.5% of LT candidates have PPH, at any point in time there may be ∼1300 PPH-LT candidates [27]. The outcome of PPH following LT remains unpredictable despite screening, careful patient selection, higher priority for LT, and advances in single and combination PAH-specific therapies (Table 19.4) [69][70][71][72][73][74][75][76][77][78]. Current policy adopted by the American Association for the Study of Liver Diseases (AASLD) calls for screening TTE to detect pulmonary hypertension in every patient considered for LT in the United States [79].…”

Section: Liver Transplantationmentioning

confidence: 99%

“…Finally, it should be noted that clinically significant PAH could develop de novo following LT (i.e., normal pulmonary hemodynamics are noted at the time of LT) for reasons that are clearly not understood [82]. [30,63] Case canceled in operating room [24,59,72,80] Intraoperative death [24,26,27,30,74,80] Transplant hospitalization death [24,30,47,[73][74][75]77,78,80] PPH Post-LT resolved; PAH-specific discontinued [30,47,48,50,51,56,62,63,65,70] resolved/stable without PAH-specific therapy [12,23,47,71,77] improved/stabilized/PAH-specific therapy continued [30,50,53,56,[61][62][63]69] progressive despite PAH-specific therapy [24] Late death not due to PPH …”

Section: Liver Transplantationmentioning

confidence: 99%