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 19 February 2018

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News

Portopulmonary hypertension in candidates for liver transplantation

Researchers in the February issue of Hepatology find that Doppler echocardiography is a highly sensitive tool for detecting portopulmonary hypertension.

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Portopulmonary hypertension represents a major risk factor for transplantation, making preoperative detection crucial.

In this study, researchers from France determined whether Doppler echocardiography is a reliable tool for detecting portopulmonary hypertension. They also assessed the incidence of acquired portopulmonary hypertension profile after evaluation.

The research team reviewed 165 patients who had Doppler echocardiography and right heart catheterization at evaluation, over a 9-year period.

All patients had a prospective follow-up.

There were no false negatives for echocardiography.
Hepatology

The researchers compared the results of catheterization at evaluation, with those obtained at the time of transplantation.

Of the 165 patients, 17 met the criteria for portopulmonary hypertension on Doppler echocardiography.

The team confirmed portopulmonary hypertension by catheterization in 10 patients, but this was ruled out in 7.

The team found that there were no false negatives for echocardiography.

The mean pulmonary artery pressure was significantly higher during the initial phase of transplantation than at evaluation. The team identified no significant correlation between values obtained at these 2 time points.

Additionally, 3 patients acquired portopulmonary hypertension profile while waiting for a graft, during a 2.5 to 5 month time interval.

Dr Isabelle Colle’s team concluded, “Doppler echocardiography is a highly sensitive tool for detecting portopulmonary hypertension”.

“However, because this technique has a poor positive predictive value, right heart catheterization is recommended for confirming portopulmonary hypertension.”

“In addition, the absence of portopulmonary hypertension at evaluation does not exclude the occasional occurrence of acquired portopulmonary hypertension profile after listing.”

In a related article in the same publication, Dr Michael Fallon also discusses portopulmonary hypertension.

He concludes, “It is clearly too early to recommend serial screening Doppler echocardiography for portopulmonary hypertension in clinical practice”.

“However, defining if and how portopulmonary hypertension develops rapidly in cirrhotic patients is likely to provide important new pathophysiologic insights.”

Hepatology 2003; 37: 253-5, 401-9
30 January 2003

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