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 17 January 2018

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News

Liver transplantation for patients with pulmonary hypertension is feasible

The majority of patients with moderate and severe pulmonary hypertension can survive liver transplantation if the cardiac index is preserved, and will not die of this during long-term follow-up, claim researchers from Birmingham, England.

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The team examined the outcome of liver transplantation for patients with pulmonary hypertension (PHT), and reported their findings in the April issue of Liver Transplantation.

A total of 145 patients who underwent liver transplantation between 1997 and 1999 were included.

Pulmonary artery pressures (PAPs) were measured before surgery.

Pre-transplantation workup included electrocardiography and echocardiography for the majority of patients.

Also, the liver unit database was screened for patients with known PHT who had undergone transplantation before 1997.

Based on pulmonary floatation catheter measurements made after the induction of anesthesia for transplantation, PHT was defined as mild or moderate to severe if the mean PAP exceeded 25 and 35 mm Hg, respectively.

The incidence of PHT was 26% (38 of 145 patients); 31 of 38 patients had mild PHT.

No survival disadvantage for transplant patients with pulmonary hypertension.
Liver Transplantation

Kaplan-Meier survival analysis did not show a significant survival benefit for patients with normal PAPs compared with patients with PHT (all, mild, moderate to severe).

For surviving patients, the duration of ventilation and intensive care unit stay was unaffected by PHT.

Some 4 of 5 patients (identified from the database 1982 to 1999) with mean PAPs greater than 40 mm Hg survived transplantation by more than 1 year.

PHT of this severity was usually associated with specific and suggestive abnormality of the echocardiogram.

Peter Starkel, of the Queen Elizabeth Hospital in Birmingham said on behalf of his colleagues, "Mild PHT is common and does not affect patient outcome after liver transplantation. Moderate and severe PHT are uncommon.

"Echocardiography detects most severe PHT, but not mild and moderate PHT."

"Our analysis suggests that when the cardiac index is preserved, the majority of patients with moderate and severe PHT can survive transplantation, and they will not die of PHT during long-term follow-up," he concluded.

Liver Transpl 2002; 8: 382-8
24 April 2002

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