Porto-pulmonary hypertension (POPH), once considered an absolute contraindication for liver transplantation (LT), has become a more accepted indication because of the evolution of treatment with prostacyclin analogues, phosphodiesterase inhibitors and endothelin receptor antagonists. An exception MELD score of 22 is assigned to candidates with documentation of effective treatment. We examined the post-transplant outcomes of patients who received LT for POPH with exception.
Methods
Scientific Registry of Transplant Recipients data on 34318 adult (≥18years) deceased donor LT recipients transplanted between 3/1/2002 and 8/31/2010 were reviewed. The diagnosis of POPH was ascertained from MELD exception forms. Patients were followed from the time of transplant until the earlier of death or end of the follow-up period. Cox-regression was used to evaluate the predictors of post-LT mortality and graft failure.
Results
During the study period, 34318 patients received deceased donor LT. Seventy eight out of 34318 patients were transplanted for POPH with MELD exception. The 1-year adjusted risks of patient death and graft failure for patients transplanted under exception rules for POPH were significantly higher than with POPH adult recipients who did not receive exception points (death: hazard ratio [HR]=2.25, p=0.005); graft failure (HR=1.96, p=0.012).
Conclusions
This study of national data suggests that treated POPH continues to be associated with inferior early post-transplant outcomes.
Tic disorders (TD) are a group of developmental neuropsychiatric conditions in which an individual experiences motor and/or vocal tics beginning around the age of 5-8 years (Bitsko et al., 2014). TD are characterized by tics, which are brief, involuntary, non-rhythmic, recurrent, rapid, stereotyped motor movements or vocalisations that are often triggered by aversive interoceptive experiences (Ganos et al., 2015). TD are expressed across a continuum of severity and duration (Muller-Vahl, Sambrani, & Jakubovski, 2019) and include provisional tic disorders (PTD, tics present for less than a year), persistent/chronic tic disorders (CTD, isolated motor or vocal tics that last over 1 year) and Tourette syndrome (TS, motor and at least one vocal tic lasting more than a year; American Psychiatric Association, 2013). These diagnoses are categorized on the spectrum of TD with PTD often being less intensive and CTD and TS potentially being more severe (Muller-Vahl, Sambrani, et al., 2019). As many as 90% of
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