Liver Transplant Outcomes in Patients With Postcapillary Pulmonary Hypertension

Abstract

Liver TransplantationBackground. Postcapillary pulmonary hypertension (PH) can be seen in cirrhosis. Research and treatment goals exist for patients with portopulmonary hypertension but not for postcapillary PH. The aim of this study was to investigate outcomes after liver transplant (LT) for patients with postcapillary PH. Methods. This was a retrospective cohort study of 1173 patients who underwent LT at our center between 2010 and 2020. Using a propensity score matched analysis followed by multivariable Cox modeling on matched patients, we compared post-LT survival between patients with and without postcapillary PH. We also compared several post-LT outcomes between patient with different types of PH. Results. Sixty-eight patients had PH, and 50 had postcapillary PH. The median age was 59 y and the sample was 54% male. There was no significant difference in mortality between patients with postcapillary PH and patients without PH (hazard ratio, 1.72; 95% confidence interval, 0.90-3.31; P = 0.10). There was no significant difference in survival between patients with any type of PH and those without PH. There was no significance difference in post-LT survival, acute kidney injury, or pulmonary edema between patients with different types of PH. Patients with postcapillary PH who survived had a higher cardiac output than those who died (11 L/min in patients who lived, as compared with 8 L/min in patients who died; P = 0.03). Conclusions. Postcapillary PH does not appear to convey a negative impact on post-LT survival. A higher cardiac output may be protective against mortality in patients with postcapillary PH.

Association of Cardiopulmonary Hemodynamics and Mortality in Veterans With Liver Cirrhosis: A Retrospective Cohort Study

“…The prevalence of PH and PoPH in this study was considerably higher compared with nonveteran populations, maintained even when a conservative mPAP threshold (>25 mm Hg) was used to classify patients. 33 , 34 , 35 , 36 , 37 For example, in a prospective study of 1235 nonveteran patients with Child–Pugh class B or C liver dysfunction referred for RHC, mPAP>20 mm Hg was identified in only 7.9% of subjects, and “classically” defined PoPH in 5.3% of subjects. 33 Similarly, 2 European studies of candidates for liver transplant referred for RHC testing identified PoPH in 4.6% to 4.8% of subjects.…”

“…We used a combination of ICD‐10 codes and laboratory values to identify patients with portal hypertension, but confirmation via direct portal pressure measurements was not available and alternative reasons for fulfilling diagnostic criteria other than portal hypertensive liver disease are possible. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 We assessed medication usage within 90 days following RHC testing using a validated methodology, 25 , 48 but this approach may nonetheless have missed some patients who were initiated on targeted therapy beyond our 90‐day time point or received medication from entities outside of the VA system.…”

Pulmonary Issues in Chronic Liver Disease

“…Up to 20% of patients undergoing LT have elevated pulmonary pressures; however, only 4% of patients have true PoPH [30]. More recent evidence shows the overall incidence of PH in patients undergoing LT is around 5.8%; of this, 73% are postcapillary PH, 14% PoPH, and 11.8% PH because of high cardiac output [31].…”

Portopulmonary hypertension: A focused review for the internist

“…tension, as postcapillary pulmonary hypertension does not appear to have a negative impact on survival after liver transplant. 43 ■…”