Portopulmonary hypertension in the early phase following liver transplantation.
BACKGROUND
Portopulmonary hypertension (PPH) is a severe complication of liver cirrhosis, which poses a high risk for postliver transplantation (LT) mortality. In most liver transplant centers, severe PPH is viewed as an absolute contraindication for LT, but recent reports challenge this. The purpose of our study was to determine the incidence of PPH, its influence on the 30-day mortality rate following LT and to determine the sensitivity and specificity of Doppler echocardiography and electrocardiography as noninvasive tools to determine PPH.


METHODS
We studied 74 consecutive patients that underwent LT between February 2004 and November 2005. Pulmonary arterial pressure and cardiac index were repeatedly determined during surgery and postoperatively. PPH was defined as mild (mean pulmonary arterial pressure (MPAP) 25-35 mm Hg), moderate (MPAP of 35-45 mm Hg) and as severe (MPAP >45 mm Hg).


RESULTS
The total incidence of PPH was 31% (16 mild, 5 moderate, and 2 severe). There was a tendency towards increased 30-day mortality rate in patients with PPH compared to controls (22% vs. 12%, P=0.1). However, the two patients with the most severe PPH survived. The duration of ventilation and total stay at the intensive care unit did not differ significantly between groups. The positive predictive value of Doppler echocardiography for PPH was 39% and the negative predictive value 90%.


CONCLUSIONS
Mild pulmonary hypertension is common in patients with liver failure, whereas moderate and severe hypertension is not. Severe PPH should not be considered as absolute contraindication for LT.
Saner
Fuat H
FH
Department of General Surgery and Transplantation, University Clinic Essen, Germany.
Nadalin
Silvio
S
Pavlaković
Goran
G
Gu
Yanli
Y
Olde Damink
Steven W M
SW
Gensicke
Julia
J
Fruhauf
Nils R
NR
Paul
Andreas
A
Radtke
Arnold
A
Sotiropoulos
Georgios C
GC
Malagó
Massimo
M
Broelsch
Christoph E
CE
D001794:Blood Pressure; D004562:Electrocardiography; D004569:Electroencephalography; D006334:Heart Function Tests; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000503:physiopathology; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000503:physiopathology*; D011184:Postoperative Period; D012189:Retrospective Studies