Successful liver transplantation following medical management of portopulmonary hypertension: A single-center series

N. Sussman, V. Kaza, N. Barshes, R. Stribling, J. Goss, C. O'Mahony, E. Zhang, J. Vierling, A. Frost

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2177-2182
Number of pages6
JournalAmerican Journal of Transplantation
Volume6
Issue number9
DOIs
StatePublished - Sep 2006

Fingerprint

Liver Transplantation
Hypertension
Transplantation
Vasodilator Agents
Epoprostenol
Waiting Lists
Feasibility Studies
Pulmonary Hypertension
Cardiac Output
Vascular Resistance
Pulmonary Artery
Hemodynamics
Transplants
Safety
Pressure
Lung

Keywords

  • Liver cirrhosis
  • Liver transplantation
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Immunology

Cite this

Successful liver transplantation following medical management of portopulmonary hypertension : A single-center series. / Sussman, N.; Kaza, V.; Barshes, N.; Stribling, R.; Goss, J.; O'Mahony, C.; Zhang, E.; Vierling, J.; Frost, A.

In: American Journal of Transplantation, Vol. 6, No. 9, 09.2006, p. 2177-2182.

Research output: Contribution to journalArticle

Sussman, N. ; Kaza, V. ; Barshes, N. ; Stribling, R. ; Goss, J. ; O'Mahony, C. ; Zhang, E. ; Vierling, J. ; Frost, A. / Successful liver transplantation following medical management of portopulmonary hypertension : A single-center series. In: American Journal of Transplantation. 2006 ; Vol. 6, No. 9. pp. 2177-2182.
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