Pulmonary hypertension as a predictor of postoperative complications and mortality after liver transplantation.
Most transplant centers consider severe pulmonary hypertension (PHT) to be an absolute contraindication for orthotopic liver transplantation (OLT). We retrospectively examined the outcome of 24 patients with PHT (group 1) who underwent OLT compared with 24 matched patients (group 2) without PHT, who also underwent OLT. Based on right cardiac catheterization measurements made after the induction of anesthesia for OLT, PHT was defined as mild or moderate-to-severe if the mean pulmonary arterial pressure exceeded 25 or 35 mm Hg, respectively. The incidence of PHT was 9.8% (24/244); 21/24 PHT patients showed mild and 3/24 moderate PHT. Kaplan-Meier survival analysis did not show a significant difference between the two groups. The incidence of pulmonary infections was significantly greater in group 1 (P < .05). The duration of ventilation and intensive care unit stay was similar in the two groups. Echocardiography detected only the three moderate cases of PHT and not the twenty-one cases of mild PHT. Our analysis suggested that mild PHT was common and did not affect patient outcomes after OLT; moderate or severe PHT was uncommon. The two patients with moderate PHT survived OLT and did not succum to PHT during long-term follow-up.
Division of Anesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria di Modena-Policlinico, Modena, Italy. lesley.depietri@yahoo.it
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De Pietri
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Montalti
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Begliomini
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Reggiani
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Lancellotti
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Giovannini
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Di Benedetto
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Guerrini
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Serra
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Rompianesi
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Pasetto
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Gerunda
D000328:Adult; D001794:Blood Pressure; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D003971:Diastole; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D017093:Liver Failure / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013599:Systole; D014463:Ultrasonography