title: Development of pulmonary hypertension in 5 patients after pediatric living-donor liver transplantation: de novo or secondary?
abstract: The development of portopulmonary hypertension (PH) in a patient with end-stage liver disease is related to high cardiac output and hyperdynamic circulation. However, PH following liver transplantation is not fully understood. Of 617 pediatric patients receiving transplants between June 1990 and March 2004, 5 (median age 12 yr, median weight 24.5 kg) were revealed to have portopulmonary hypertension (PH) after living-donor liver transplantation (LDLT), as confirmed by echocardiography and/or right heart catheterization. All children underwent LDLT for post-Kasai biliary atresia. In 2 patients with refractory biliary complications, PH developed following portal thrombosis; 2 with stable graft function, who had had intrapulmonary shunting (IPS) before LDLT, were found to have PH in spite of overcoming liver dysfunction due to hepatitis. PH developed shortly after distal splenorenal shunting in 1 patient, who suffered liver cirrhosis due to an intractable outflow blockage. The onset of PH ranged from 2.8 to 11 yr after LDLT, and mean pulmonary artery pressure (mPAP) estimated by echocardiography at the time of presentation ranged from 43 to 120 mmHg. Three of the 5 patients are alive under prostaglandin I2 (PGI2) treatment. Of these, 1 is prepared for retransplantation for an intractable complications of liver allograft, while the other 2 with satisfactory grafts are being considered for lung transplantation. Even after LDLT, PH can develop with portal hypertension. Periodic echocardiography is essential for early detection and treatment of PH especially in the recipients with portal hypertension not only preoperatively but also postoperatively.
authors.affiliation: Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. yasumuasa@indigo.plala.or.jp
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Shirouzu
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Kaoru
authors.initials: K
authors.lastname: Taira
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Hiraku
authors.initials: H
authors.lastname: Doi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male