TY - JOUR
T1 - Successful liver transplantation following medical management of portopulmonary hypertension
T2 - A single-center series
AU - Sussman, N.
AU - Kaza, V.
AU - Barshes, N.
AU - Stribling, R.
AU - Goss, J.
AU - O'Mahony, C.
AU - Zhang, E.
AU - Vierling, J.
AU - Frost, A.
PY - 2006/9
Y1 - 2006/9
N2 - Severe portopulmonary hypertension (POPH) is an absolute contraindication to orthotopic liver transplantation (OLT). Vasodilators have been used, but the safety of subsequent transplantation and the reversibility of pulmonary hypertension after transplantation are uncertain. This study examined the feasibility and post-transplant effects of liver transplantation following medical control of POPH. Eight consecutive patients (three females and five males, ages 39-51) with POPH as their only contraindication to transplantation were treated with continuous intravenous epoprostenol. Liver transplantation was considered if the mean pulmonary artery pressure (PAM) was lowered to <35 mmHg. Epoprostenol 2-8 ng/kg/min successfully improved hemodynamics in seven of eight patients, usually within 6.5 months of initiating therapy. PAM declined from an average of 43-33 mmHg (p = 0.03); mean pulmonary vascular resistance declined from 410 to 192 dyn s cm-5 (p = 0.01) and cardiac output increased from 6.6 to 10 L/min (p = 0.02). Six of the seven responders were actively listed for liver transplantation. Two died on the waiting list; the remaining four were transplanted and remain alive and well 9-18 months post-OLT - two without vasodilators, and two on oral medication. We conclude that pulmonary vasodilators permit safe liver transplantation in some cases, and that POPH may be reversible after transplantation.
AB - Severe portopulmonary hypertension (POPH) is an absolute contraindication to orthotopic liver transplantation (OLT). Vasodilators have been used, but the safety of subsequent transplantation and the reversibility of pulmonary hypertension after transplantation are uncertain. This study examined the feasibility and post-transplant effects of liver transplantation following medical control of POPH. Eight consecutive patients (three females and five males, ages 39-51) with POPH as their only contraindication to transplantation were treated with continuous intravenous epoprostenol. Liver transplantation was considered if the mean pulmonary artery pressure (PAM) was lowered to <35 mmHg. Epoprostenol 2-8 ng/kg/min successfully improved hemodynamics in seven of eight patients, usually within 6.5 months of initiating therapy. PAM declined from an average of 43-33 mmHg (p = 0.03); mean pulmonary vascular resistance declined from 410 to 192 dyn s cm-5 (p = 0.01) and cardiac output increased from 6.6 to 10 L/min (p = 0.02). Six of the seven responders were actively listed for liver transplantation. Two died on the waiting list; the remaining four were transplanted and remain alive and well 9-18 months post-OLT - two without vasodilators, and two on oral medication. We conclude that pulmonary vasodilators permit safe liver transplantation in some cases, and that POPH may be reversible after transplantation.
KW - Liver cirrhosis
KW - Liver transplantation
KW - Pulmonary hypertension
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U2 - 10.1111/j.1600-6143.2006.01432.x
DO - 10.1111/j.1600-6143.2006.01432.x
M3 - Article
C2 - 16796721
AN - SCOPUS:33746909482
SN - 1600-6135
VL - 6
SP - 2177
EP - 2182
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 9
ER -