Pulmonary Hypertension and Liver Transplantation

Wolf, André M. De; Scott, Victor L.; Gasior, Thomas A.; Y, Rang

doi:10.1097/00000542-199301000-00037

Cited by 87 publications

(45 citation statements)

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“…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).…”

Section: Discussionmentioning

confidence: 99%

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Severe pulmonary hypertension in liver transplant candidates

et al. 1997

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Advanced liver disease with portal hypertension may be associated with pulmonary hypertension. A review of 1,205 consecutive liver transplant patients was made to assess the incidence and severity of pulmonary hypertension in patients with end-stage liver disease. Postoperative data were reviewed to determine if outcome was influenced and, in patients with severe pulmonary hypertension, whether pulmonary hypertension was reversed after transplantation. The hemodynamic data of 5 patients who were found to have severe pulmonary hypertension before transplantation and did not receive transplants were also reviewed. The incidence of pulmonary hypertension in the patients who received transplants was 8.5% (n ‫؍‬ 102; mean pulmonary artery pressure, G25 mmHg). The incidence of mild pulmonary hypertension was 6.72% (n ‫؍‬ 81; systolic pulmonary artery pressure, 30 to 44 mmHg); that of moderate pulmonary hypertension was 1.16% (n ‫؍‬ 14; systolic pulmonary artery pressure, 45 to 59 mmHg); and that of severe pulmonary hypertension was 0.58% (n ‫؍‬ 7; systolic pulmonary artery pressure, G60 mmHg). Mild and moderate pulmonary hypertension did not influence the outcome of the procedure. Severe pulmonary hypertension was associated with mortality rates of 42% at 9 months posttransplantation and 71% at 36 months posttransplantation. Only 2 of 7 patients with severe pulmonary hypertension have survived liver transplantation with a good quality of life. The remaining 5 patients continued to deteriorate with progressive right heart failure with no evidence of amelioration of the pulmonary hypertension. This experience supports the view that in most patients who have severe pulmonary hypertension associated with advanced liver disease, it is caused by fixed pathological changes in the pulmonary vasculature, is not reversible with liver transplantation, and is associated with a very high perioperative mortality rate. Copyright 1997 by the American Association for the Study of Liver DiseasesA review of perioperative data was undertaken to establish the incidence of pulmonary hypertension in the first 1,205 consecutive orthotopic liver transplant (OLT) patients at Baylor University Medical Center (BUMC) and to elucidate whether the presence of pulmonary hypertension influenced the clinical outcome. Mild to moderate pulmonary hypertension has not been reported to contribute to mortality after transplant or to influence the clinical outcome. 1-3 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. Patients and MethodsWe have defined pulmonary hypertension as a mean pulmonary artery pressure of 25 mmHg or greater and a pulmonary vascular resistance (PVR) of greater than 120 dyne · s Ϫ1 · cm Ϫ5 . 3 Pulmonary hypertension was then arbitrarily divided into three gro...

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Section: Discussionmentioning

confidence: 99%

“…[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.…”

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confidence: 99%

Severe pulmonary hypertension in liver transplant candidates

et al. 1997

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“…The ability to control PVR may suggest these patients could be successfully managed during liver transplantation, as in the initial report of NO use, 13 but the ability to reduce MPAP and PVR in a resting stable patient may not translate to an ability to do so intraoperatively. This, along with the poor outcome of patients with PPHTN undergoing liver transplantation, 5,6,24 implies this would not be a suitable use for inhaled NO. In primary pulmonary hypertension, NO can be used as a screening vasodilator.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] When patients with PPHTN undergo liver transplantation, perioperative mortality is high. 5,6 Vasodilators, in particular, nifedipine and epoprostenol, have been shown to reduce symptoms and prolong life in patients with primary pulmonary hypertension, 7,8 and epoprostenol has been shown to reduce pulmonary artery pressures (PAPs) in patients with PPHTN. 9 However, all have systemic effects that may limit their usefulness; epoprostenol may also cause hypersplenism in patients with portal hypertension.…”

Section: P Ortopulmonary Hypertension (Pphtn) Is Amentioning

confidence: 99%

Inhaled nitric oxide reduces pulmonary artery pressures in portopulmonary hypertension

et al. 1999

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Pulmonary artery hypertension in association with liver failure (portopulmonary hypertension [PPHTN]) is a significant barrier to liver transplantation because patients with this condition have a very high mortality when transplantation is undertaken. Inhaled nitric oxide (NO), a potent pulmonary vasodilator, reduces pulmonary artery pressure (PAP) in some patients with primary pulmonary hypertension, but its effect in patients with PPHTN is controversial. We investigated the hemodynamic effects of inhaled NO in 6 patients with PPHTN. Five of 6 patients responded to NO inhalation with decreases in PAP and pulmonary vascular resistance of greater than 10%; these decreases were statistically significant at NO concentrations of 10 and 30 ppm. Cardiac output did not significantly change. We conclude that inhalation of NO reduces PAPs in some patients with PPHTN.

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“…Such patients have a high mortality when they undergo liver transplantation. [1][2][3] Current therapy aims at reducing pulmonary artery pressure (PAP) in these patients in the hope this will improve perioperative transplant survival. Continuous intravenous (IV) infusion of epoprostenol has been shown to improve symptoms, decrease PAP, and prolong life in patients with primary pulmonary hypertension in the nontransplant setting.…”

mentioning

confidence: 99%

Progressive splenomegaly after epoprostenol therapy in portopulmonary hypertension

et al. 1999

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Patients with end-stage liver failure, portal hypertension, and associated pulmonary artery hypertension (portopulmonary hypertension [PPHTN]) have a high mortality when undergoing liver transplantation. Successful transplantation in these patients may depend on efforts to reduce pulmonary artery pressure (PAP). To this end, a number of centers are using a continuous intravenous (IV) infusion of epoprostenol, which has been shown to improve symptoms, extend life span, and reduce PAP in patients with primary pulmonary hypertension. We report four cases in which treatment of patients with PPHTN with continuous IV epoprostenol was followed by the development of progressive splenomegaly, with worsening thrombocytopenia and leukopenia. This finding may limit the usefulness of epoprostenol in PPHTN and influence the timing of transplantation in such patients.

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Pulmonary Hypertension and Liver Transplantation

Cited by 87 publications

References 0 publications

Severe pulmonary hypertension in liver transplant candidates

Severe pulmonary hypertension in liver transplant candidates

Inhaled nitric oxide reduces pulmonary artery pressures in portopulmonary hypertension

Progressive splenomegaly after epoprostenol therapy in portopulmonary hypertension

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