Portopulmonary Hypertension and the Liver Transplant Candidate

Kuo, Paul C.; Plotkin, Jeffrey S.; Gaine, Seán; Schroeder, Rebecca A.; Rustgi, Vinod K.; Rubin, Lewis J.; Johnson, Lynt B.

doi:10.1097/00007890-199904270-00001

Cited by 125 publications

(92 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When the MPAP is > �0 mmHg, the condition becomes life threatening and can mmHg, the condition becomes life threatening and can mmHg, the condition becomes life threatening and can lead to right ventricular failure and hypoxemia. If surgery is contemplated, pulmonary pressures must be optimized usually with intravenous epoprostenol [28] , but sildenafil or bosentan have also been tried perioperatively.…”

Section: Pulmonary Conditionsmentioning

confidence: 99%

Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

Millwala

Nguyen²,

Thuluvath

2007

WJG

117

View full text Add to dashboard Cite

The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize postsurgical outcomes. © 2007 WJG . All rights reserved.Key words: P r e -ope r at ive r is k as s e s s me nt ; Ris k stratification; Cirrhosis; Model for end-stage liver disease; Non-transplant surgery; Outcomes Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management. World J Gastroenterol 2007; 13(30): 4056-4063

show abstract

Section: Pulmonary Conditionsmentioning

confidence: 99%

Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

Millwala

Nguyen²,

Thuluvath

2007

WJG

117

View full text Add to dashboard Cite

show abstract

“…2 As a consequence, many authors consider that severe portopulmonary hypertension (i.e., mean pulmonary artery pressure [MPAP] above 40 mm Hg) represents a contraindication for liver transplantation because it would carry an unacceptable mortality rate. 3 Because portopulmonary hypertension is frequently asymptomatic until mean pulmonary pressure exceeds 40 mm Hg, most authors recommend systematic screening at evaluation. Several studies have suggested that Doppler echocardiography, when performed during pretransplantation evaluation, is a useful noninvasive tool to document or exclude portopulmonary hypertension, [4][5][6] even though this technique carries a significant proportion of false positives.…”

mentioning

confidence: 99%

Diagnosis of portopulmonary hypertension in candidates for liver transplantation: A prospective study

et al. 2003

View full text Add to dashboard Cite

Portopulmonary hypertension represents a major risk factor for transplantation; therefore, preoperative detection is crucial. The aims of this study were to determine (1) whether Doppler echocardiography performed at evaluation is a reliable tool for detecting portopulmonary hypertension and (2) the incidence of acquired portopulmonary hypertension profile after evaluation. One hundred sixty-five patients had Doppler echocardiography and right heart catheterization at evaluation over a 9-year period. All patients had a prospective follow-up, and the results of catheterization at evaluation were compared with those obtained at the time of transplantation. Seventeen of 165 patients met the criteria for portopulmonary hypertension on Doppler echocardiography. Portopulmonary hypertension was confirmed by catheterization in 10 patients and ruled out in 7. There were no false negatives for echocardiography. Mean pulmonary artery pressure was significantly higher during the initial phase of transplantation than at evaluation (17.8 ؎ 4.3 vs. 20.3 ؎ 5.5 mm Hg, respectively, P < .0001), and there was no significant correlation between values obtained at these 2 time points. Three patients showed to have acquired portopulmonary hypertension profile while waiting for a graft within time intervals ranging from 2.5 to 5 months. In conclusion, 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. P ulmonary hypertension associated with portal hypertension, the so-called portopulmonary hypertension, is a rare complication of cirrhosis. When severe, this condition is a major risk factor for transplantation because, in most cases, patients are at best partially responsive to medical therapies. 1 If it is impossible to lower mean pulmonary artery pressure below 40 to 50 mm Hg during transplantation procedure, any significant hemodynamic changes, such as those observed at the time of caval clamping and reperfusion of the graft, may result in irreversible cardiac arrest, especially if right ventricular function is impaired. 2 As a consequence, many authors consider that severe portopulmonary hypertension (i.e., mean pulmonary artery pressure [MPAP] above 40 mm Hg) represents a contraindication for liver transplantation because it would carry an unacceptable mortality rate. 3 Because portopulmonary hypertension is frequently asymptomatic until mean pulmonary pressure exceeds 40 mm Hg, most authors recommend systematic screening at evaluation. Several studies have suggested that Doppler echocardiography, when performed during pretransplantation evaluation, is a useful noninvasive tool to document or exclude portopulmonary hypertension, 4-6 even though this technique ...

show abstract

“…This finding is slightly higher than previously reported rates of 2-12% of patients undergoing evaluation for liver transplant. 22 Of patients with pulmonary hypertension, almost three quarters had some grade of IPS, although no overall difference in mean PASP was seen in patients with and without IPS. This discrepancy could be explained by the relatively small study sample size and higher degrees of PASP in patients with IPS.…”

Section: Discussionmentioning

confidence: 90%

Clinical predictors and characteristics of patients with chronic liver disease and intrapulmonary shunts

Santa-Cruz¹,

Pearson²,

Cohen³

et al. 2005

Clin Cardiol

View full text Add to dashboard Cite

SummaryBackground: Intrapulmonary shunting (IPS) is a well-described phenomenon in chronic liver disease but its significance is not known.Hypothesis: The study was undertaken to enhance our understanding of the characteristics and prevalence of IPS.Methods: We retrospectively studied 204 consecutive patients with end-stage chronic liver disease who underwent a dobutamine stress echocardiogram, along with a saline contrast bubble study, as part of their pretransplant evaluation.Results: Intrapulmonary shunting of any degree was present in 56.4% of patients. Patients with IPS were more likely to report alcohol use and less likely to have diabetes mellitus. Patients in Child-Pugh classification C were more likely to have IPS than those with classification A or B. The resting room air PaO2 levels were significantly lower in patients with grade 3-4 IPS than in those with grade 1-2. Elevated estimated pulmonary systolic pressure on echocardiography was more prevalent in patients with than in those without IPS.Conclusions: A majority of patients with end-stage chronic liver disease undergoing transplant evaluation have IPS. There are important baseline differences between patients with and without IPS. The presence of IPS is associated with increased severity of chronic liver disease. Further study is required to define the prognostic significance of IPS and its impact on future liver transplantation.

show abstract

Portopulmonary Hypertension and the Liver Transplant Candidate

Cited by 125 publications

References 36 publications

Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

Diagnosis of portopulmonary hypertension in candidates for liver transplantation: A prospective study

Clinical predictors and characteristics of patients with chronic liver disease and intrapulmonary shunts

Contact Info

Product

Resources

About