Pulmonary Vascular Resistance Predicts Mortality and Graft Failure in Transplantation Patients With Portopulmonary Hypertension

Abstract

Earn MOC for this article: www.wileyhealthlearning.com/aasld.aspx Portopulmonary hypertension (POPH) is a pulmonary vascular disease associated with significant morbidity and mortality in those with liver disease, conferring a higher mortality in patients awaiting liver transplantation (LT). Although not a transplant indication, patients with POPH can experience significant clinical improvement following LT, and those maintaining a mean pulmonary artery pressure (MPAP) <35mm Hg and a pulmonary vascular resistance (PVR) <5 Woods units (WU) are granted additional listing points to expedite LT. The effect of POPH on posttransplant outcomes such as mortality and graft failure, however, is not well defined. We performed a retrospective cohort study of the US Organ Procurement and Transplantation Network database of all adult patients who underwent LT between January 1, 2006, and December 1, 2020. Using adjusted accelerated failure time models, we examined the relationship between a diagnosis of POPH and outcomes following LT and the relationship between pre-LT hemodynamics and post-LT survival (alive with a functioning graft) in patients with POPH. Compared with those undergoing transplants without exception points, patients with POPH had comparable post-LT survival rates but were significantly more likely to have graft failure. Both pre-LT MPAP and PVR predicted post-LT survival in POPH, with a pre-LT PVR of ≥1.6 WU, more than doubling the hazard for mortality (death or a nonfunctioning graft; coefficient, 2.01; standard error, 0.85; hazard ratio, 2.21; P = 0.02). POPH may confer a significantly higher risk of post-LT graft failure compared with patients with cirrhosis without POPH, and a pre-LT PVR of ≥1.6 WU may predict post-LT survival. Further investigation into the relationship between pre-LT hemodynamics, right ventricular function, and post-LT outcomes of mortality and graft failure in POPH is needed.

The predictive value of revised diastolic dysfunction in outcomes of liver transplantation: A propensity score matching analysis

“…Because of the limitations of current study population, possibilities of impaired ion channels cannot be completely excluded (11). Pulmonary arterial hypertension has been shown to be involved in liver fibrosis at the gene level and confers higher mortality (36)(37)(38). Cardiac dysfunction was first attributed to the direct effect of alcohol; however, it was revealed to be independent of the etiology (39, 40).…”

The Different Effects of Direct Bilirubin on Portopulmonary Hypertension and Idiopathic Pulmonary Arterial Hypertension

“…We chose PVR to conduct the correlation analysis not only because of the two-time fold change between POPH and IPAH but also because PVR could predict mortality and graft failure in transplantation patients with POPH [ 24 ]. Although total bilirubin and direct bilirubin were positively correlated with PVR, the independent predictor of PVR elevation was NT-proBNP in the IPAH group.…”

Mending the Model for End‐Stage Liver Disease: An in‐depth review of the past, present, and future portopulmonary hypertension Model for End‐Stage Liver Disease exception

“…A retrospective cohort study of the OPTN database found that a pre‐LT PVR of ≥1.6 WU was associated with an increased risk of post‐LT mortality, but because of the limitations of the database, there were no data regarding RV function or other important prognostic parameters. [ 21 ] A PVR <1.6 WU, or 128 dynes‐s‐cm −5 , is also not a realistic treatment goal for most patients with POPH. Currently, there is insufficient evidence to further modify MELD exception criteria regarding the PVR threshold, but additional research is needed to guide decisions and optimize posttransplant outcomes.…”