title: Successful Liver Transplant Complicated by Severe Portopulmonary Hypertension After an Initial Aborted Attempt: Case Report and Review of Treatment Options.
abstract: Good right ventricular function and responsiveness to vasodilator therapy are the most important prerequisites for successful liver transplant in patients with portopulmonary hypertension. A patient with portopulmonary hypertension and good right ventricular function presented for deceased-donor liver transplant. Pulmonary arterial pressure was controlled with epoprostenol and sildenafil preoperatively. After anesthesia induction, pulmonary arterial pressure increased significantly and the procedure was aborted. Additional medical treatment included aggressive vasodilator therapy and the transplant was successfully performed 1 month later. During the procedure, elevations in pulmonary arterial pressure responded to a combination of inhaled nitric oxide, intravenous milrinone and nitroglycerin, and optimization of mechanical ventilation.
authors.affiliation: From the Department of Anesthesia, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Reid
authors.forename: Patrick
authors.initials: P
authors.lastname: McQuillan
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.forename: Piotr
authors.initials: P
authors.lastname: Janicki
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology; D011651:Pulmonary Artery / Q000503:physiopathology; D012086:Reoperation; D012121:Respiration, Artificial; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D016278:Ventricular Function, Right
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents