Portopulmonary hypertension and the liver transplant candidate.
The management of the liver transplant (OLT) candidate with portopulmonary hypertension (PPHTN) has dramatically changed in the past 3 years. Careful preoperative evaluation with functional characterization of right ventricular function plays a critical role. The pulmonary vascular response to epoprostenol infusion serves as a deciding factor for OLT candidacy. Careful perioperative attention to avoid right ventricular failure from acutely elevated pulmonary artery pressures or sudden increases in right ventricular preload is a key physiologic tenet of management. With increased surgical expertise, anesthetic sophistication, and availability of epoprostenol, PPHTN is no longer considered an absolute contraindication for OLT.
Kuo
P C
PC
Department of Surgery, Georgetown University Medical Center, Washington, DC 20007, USA. kuop@gunet.georgetown.edu
Plotkin
J S
JS
Gaine
S
S
Schroeder
R A
RA
Rustgi
V K
VK
Rubin
L J
LJ
Johnson
L B
LB
D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D011184:Postoperative Period