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

Hayashi, Ryoko; Kogiso, Tomomi; Kikuchi, Noriko; Yamamoto, Kana; Nakamura, Shinichi; Egawa, Hiroto; Hagiwara, Nobuhisa; Tokushige, Katsutoshi

doi:10.1371/journal.pone.0267125

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Yoshimaru et al [ 25 ] reported that patients with PoPH had a significantly higher BNP level, which was predictive of asymptomatic PoPH, with an optimal cut-off value of 29.1 pg/mL. In our data, it was 90.8 pg/mL in patients with RVSP ≥ 36 mmHg [ 6 ]. Out of seven HPS patients, we measured serum BNP in five patients.…”

Section: Clinical Features Of Pophsupporting

confidence: 49%

“…McDonnell et al [ 2 , 3 ] showed a prevalence of histopathological changes of 0.61% in autopsies of patients with liver cirrhosis (LC), and PoPH is the fourth most common condition (approximately 10%) among PAH cases [ 2 ]. Recent cohort studies showed prevalence rates of PoPH of 1–6% in patients presenting to be evaluated for liver transplantation (LT) [ 3 , 4 , 5 , 6 ]. Patients with PoPH have an increased risk of death; their reported death rates without therapy at 1 and 5 years were 54% and 86%, respectively [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan

Tokushige

Kogiso

Egawa

2023

JCM

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Portopulmonary hypertension (PoPH) and hepatopulmonary syndrome are severe pulmonary complications associated with liver cirrhosis (LC) and portal hypertension. Three key pathways, involving endothelin, nitric oxide, and prostacyclin, have been identified in the development and progression of pulmonary arterial hypertension (PAH). To obtain a good effect with PAH-specific drugs in PoPH patients, it is important to diagnose PoPH at an early stage and promptly initiate therapy. The majority of therapeutic drugs are contraindicated for Child-Pugh grade C LC, and their effects decrease in the severe PAH stage. Among many LC patients, the measurement of serum brain natriuretic peptide levels might be useful for detecting PoPH. Previously, liver transplantation (LT) for PoPH was contraindicated; however, the indications for LT are changing and now take into account how well the PoPH is controlled by therapeutic drugs. In Japan, new registration criteria for deceased-donor LT have been established for PoPH patients. PoPH patients with a mean pulmonary arterial pressure <35 mmHg and pulmonary vascular resistance <400 dyn/s/cm−5 are indicated for LT, regardless of whether they are using therapeutic drugs. Combined with PAH-specific drugs, LT may lead to excellent long-term outcomes in PoPH patients. We aimed to review current therapies for PoPH, including LT.

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Section: Clinical Features Of Pophsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan

Tokushige

Kogiso

Egawa

2023

JCM

Self Cite

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“…As reported, plasma BNP parameters are bound up with pulmonary hypertension and cardiac function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary heart disease, implying that BNP could reflect the health condition of patients and guide their treatment 21 . A study including 157 patients with portal hypertension or decompensated cirrhosis has disclosed that BNP levels are elevated in patients with high right ventricular systolic pressures, thus predicting portopulmonary hypertension (PoPH) 22 . Moreover, BNP measurement has been demonstrated to have utility in the early diagnosis of PoPH, with a cut‐off value of 29.1 pg/mL for BNP in the prediction of the disease 23 …”

Section: Discussionmentioning

confidence: 98%

“…21 A study including 157 patients with portal hypertension or decompensated cirrhosis has disclosed that BNP levels are elevated in patients with high right ventricular systolic pressures, thus predicting portopulmonary hypertension (PoPH). 22 Moreover, BNP measurement has been demonstrated to have utility in the early diagnosis of PoPH, with a cut-off value of 29.1 pg/mL for BNP in the prediction of the disease. PTX3 is a novel and effective biomarker for the assessment of patients with PAH.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic values of serum BNP, PTX3, and VEGF in acute pulmonary embolism complicated by pulmonary artery hypertension and their correlations with severity of pulmonary artery hypertension

Zheng,

Zhang,

et al. 2023

Immunity Inflam & Disease

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ObjectiveThis paper aimed to unveil the diagnostic values of serum brain natriuretic peptide (BNP), pentraxin 3 (PTX3), and vascular endothelial growth factor (VEGF) in acute pulmonary embolism complicated by pulmonary artery hypertension (APE‐PAH) and their correlations with severity of PAH.MethodsA total of 153 patients with APE were selected for our study and divided into the PAH and Non‐PAH groups according to the measurement of pulmonary artery pressure by echocardiography. Serum BNP levels were measured by chemiluminescence immunoassay, and serum PTX3 and VEGF levels were appraised by ELISA. The predictive values of BNP, PTX3, and VEGF for APE‐PAH were evaluated by applying the receiver operating characteristic (ROC) curve. Spearman test was implemented to correlate BNP, PTX3, and VEGF with the severity of PAH.ResultsHigher serum levels of BNP, PTX3, and VEGF were observed in the PAH group versus the Non‐PAH group (p < .05). ROC curve analysis indicated that BNP, PTX3, and VEGF had acceptable diagnostic value for predicting APE‐PAH. Higher serum levels of BNP, PTX3, and VEGF were witnessed in the moderate and severe PAH groups in contrast to the mild PAH group (p < .05), and the levels of these parameters were elevated in the severe PAH group versus the moderate PAH group (p < .05). Spearman correlation analysis signified that serum BNP (r = 0.377), PTX3 (r = 0.488), and VEGF (r = 0.575) levels were positively correlated with the severity of PAH in APE‐PAH patients.ConclusionSerum BNP, PTX3, and VEGF levels are significantly elevated in APE‐PAH patients. Serum BNP, PTX3, and VEGF levels are of clinical value in the diagnosis of APE‐PAH patients, and serum BNP, PTX3, and VEGF levels are positively correlated with the severity of PAH and can be used as predictors of the severity of PAH.

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Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

et al. 2022

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Background Measurement of the tricuspid regurgitation pressure gradient (TRPG) by echocardiography is recommended as the most objective examination for the detection of portopulmonary hypertension (PoPH). This prospective study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a screening method for identifying patients most likely to bene t from investigation with echocardiography.Results Four hundreds and eighty-six patients with cirrhosis underwent Doppler echocardiography, and were analyzed in the present study. Of the 486 patients, 51 (10.5%) had TRPG ≥35 mmHg. The median BNP was 39.5 (range, 3.3-712.0) pg/mL. Ninety-one (18.7%) patients reported shortness of breath.Multivariate analysis identi ed female, shortness of breath, and BNP ≥49 pg/mL as independent factors for TRPG ≥35 mmHg. The risk score for predicting TRPG ≥35 mmHg was calculated: risk score = −3.230 + 0.622 × gender (female: 1, male: 0) + 1.403 × shortness of breath (presence: 1, absence: 0) + 0.726 × BNP (≥ 49pg/mL: 1, <49 pg/mL: 0). An optimal cut-off risk score for predicting TRPG ≥35 mmHg was −1.882 (AUC, 0.731; sensitivity, 68.6%; speci city, 70.6%). The prevalence of TRPG ≥35 mmHg in patients with a risk score ≥−1.882 (21.5%) was signi cantly higher than that in patients with a risk score <−1.882(5.0%) (p = 7.02 × 10 −8 ).Conclusions We clari ed the characteristics of patients with suspected PoPH, and developed a scoring model for identifying patients at high risk of PoPH, which may have utility in selecting patients with cirrhosis that may bene t from echocardiography.

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

Cited by 5 publications

References 32 publications

Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan

Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan

Diagnostic values of serum BNP, PTX3, and VEGF in acute pulmonary embolism complicated by pulmonary artery hypertension and their correlations with severity of pulmonary artery hypertension

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

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