Maud Reymond1, Louise Barbier2,3, Ephrem Salame2,3, Camille Besh4, Jérome Dumortier5, Georges-Philippe Pageaux6, Christophe Bureau7, Sébastien Dharancy8, Claire Vanlemmens9, Armand Abergel10, Marie-Lorraine Woehl Jaegle4, Pascal Magro11, Frederic Patat12, Emeline Laurent13, Jean-Marc Perarnau1. 1. Department of Hepatology, Trousseau University Hospital, Tours, France. 2. Department of Hepatobiliary Surgery and Liver Transplantation, Trousseau University Hospital, Tours, France. 3. FHU SUPORT, Tours, France. 4. Department of Hepatology, Hautepierre University Hospital, Strasbourg, France. 5. Department of Hepatology, Herriot University Hospital, Lyon, France. 6. Department of Hepatology, St Eloi University Hospital, Montpellier, France. 7. Department of Hepatology, Purpan University Hospital, Toulouse, France. 8. Department of Hepatology, Huriez University Hospital, Lille, France. 9. Department of Hepatology, Minjoz University Hospital, Besançon, France. 10. Department of Hepatology, Estaing University Hospital, Clermont-Ferrand, France. 11. Department of Pneumology, Bretonneau University Hospital, Tours, France. 12. Echography-Doppler, Bretonneau University Hospital, Tours, France. 13. Service of Public Health, Epidemiology Bretonneau University Hospital, Research Team EE1 EES, Francois Rabelais University, Tours, France.
Abstract
BACKGROUND: Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension associated with portal hypertension. Its presence is a major stake for cirrhotic patients requiring liver transplantation (LT), with increased postoperative mortality and unpredictable evolution after transplantation. The aim was to study outcomes after liver transplantation in patients with portopulmonary hypertension and to identify factors associated with normalization of pulmonary hypertension. METHODS: Patients with portopulmonary hypertension who underwent LT between 2008 and 2016 in 8 French centers were retrospectively included. Pulmonary artery pressure was established by right heart catheterization before and after LT. Primary endpoint was the normalization of pulmonary artery pressure after LT. RESULTS: Twenty-three patients who received liver transplant between 2008 and 2016 were included. Two (8.7%) patients died in the immediate posttransplant period from right heart failure. With appropriate vasoactive medical treatment and LT, pulmonary arterial pressure was normalized in 14 patients (60.8%), demonstrating recovery from portopulmonary hypertension. In univariate analysis, the use of vasoactive combination therapy was the only prognostic factor for pulmonary arterial hypertension normalization after LT. CONCLUSIONS: Treatment of portopulmonary hypertension with a combination of vasoactive drugs allows LT with acceptable postoperative cardiovascular-related mortality and normalization of pulmonary hypertension in the majority of the patients.
BACKGROUND: Portopulmonary hypertension is defined by the presence of pulmonary arterial hypertension associated with portal hypertension. Its presence is a major stake for cirrhoticpatients requiring liver transplantation (LT), with increased postoperative mortality and unpredictable evolution after transplantation. The aim was to study outcomes after liver transplantation in patients with portopulmonary hypertension and to identify factors associated with normalization of pulmonary hypertension. METHODS:Patients with portopulmonary hypertension who underwent LT between 2008 and 2016 in 8 French centers were retrospectively included. Pulmonary artery pressure was established by right heart catheterization before and after LT. Primary endpoint was the normalization of pulmonary artery pressure after LT. RESULTS: Twenty-three patients who received liver transplant between 2008 and 2016 were included. Two (8.7%) patients died in the immediate posttransplant period from right heart failure. With appropriate vasoactive medical treatment and LT, pulmonary arterial pressure was normalized in 14 patients (60.8%), demonstrating recovery from portopulmonary hypertension. In univariate analysis, the use of vasoactive combination therapy was the only prognostic factor for pulmonary arterial hypertension normalization after LT. CONCLUSIONS: Treatment of portopulmonary hypertension with a combination of vasoactive drugs allows LT with acceptable postoperative cardiovascular-related mortality and normalization of pulmonary hypertension in the majority of the patients.
Authors: Arun Jose; Shimul A Shah; Nadeem Anwar; Courtney R Jones; Kenneth E Sherman; Jean M Elwing Journal: Liver Transpl Date: 2021-06-29 Impact factor: 6.112
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Authors: Fatih Türker; Tolga Sahın; Alihan Oral; Erdem Koçak; Betül Çavuşoğlu Türker; Adil Niğdelioğlu; Hayriye Esra Ataoğlu Journal: Int J Gen Med Date: 2022-01-25