title: Outcomes of liver transplantation for porto-pulmonary hypertension in model for end-stage liver disease era.
abstract: Porto-pulmonary hypertension (POPH), once considered an absolute contraindication for liver transplantation (LT), has become a more accepted indication because of the evolution of treatment with prostacyclin analogues, phosphodiesterase inhibitors and endothelin receptor antagonists. An exception model for end stage liver disease (MELD) score of 22 is assigned to candidates with documentation of effective treatment. We examined the post-transplant outcomes of patients who received LT for POPH with exception.
  
  
  METHODS
  Scientific Registry of Transplant Recipients data on 34,318 adult (≥ 18 years) deceased donor LT recipients transplanted between March 1, 2002 and August 31, 2010 were reviewed. The diagnosis of POPH was ascertained from MELD exception forms. Patients were followed from the time of transplant until the earlier occurrence of death or end of the follow-up period. Cox regression was used to evaluate the predictors of post-LT mortality and graft failure.
  
  
  RESULTS
  During the study period, 34,318 patients received deceased donor LT. Seventy eight out of 34,318 patients were transplanted for POPH with MELD exception. The 1-year adjusted risks of patient death and graft failure for patients transplanted under exception rules for POPH were significantly higher than with POPH adult recipients who did not receive exception points (death:hazard ratio [HR] = 2.25, p = 0.005 and graft failure HR = 1.96, p = 0.012).
  
  
  CONCLUSIONS
  This study of national data suggests that treated POPH continues to be associated with inferior early post-transplant outcomes.
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Reena J
authors.initials: RJ
authors.lastname: Salgia
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Goodrich
authors.forename: Heather
authors.initials: H
authors.lastname: Simpson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Pratima
authors.initials: P
authors.lastname: Sharma
mesh_terms: D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D006976:Hypertension, Pulmonary / Q000150:complications*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology