Portopulmonary hypertension: Still an appropriate consideration for liver transplantation?

Research output: Contribution to journalArticle

Authors

  • Suman Verma
  • Fiona Hand
  • Marie de Vos
  • Douglas Thorburn
  • Terry Pan
  • John Klinck
  • Rachel H Westbrook
  • Georg Auzinger
  • Andrew Bathgate
  • Steven Masson
  • Andrew Holt
  • Diarmaid D Houlihan
  • James W Ferguson

Colleges, School and Institutes

External organisations

  • Institute of Liver Studies, King's College Hospital, London, United Kingdom.
  • National Liver Unit, St. Vincent's University Hospital, Dublin, Ireland.
  • The Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
  • UCL Centre for Nephrology, Royal Free Hospital, London, United Kingdom.
  • University of Cambridge
  • Scottish Transplant Unit, Edinburgh, United Kingdom.
  • Freeman Hospital, Newcastle, United Kingdom.

Abstract

Liver transplantation (LT) in patients with portopulmonary hypertension (PoPH) has historically resulted in unpredictable and often poor outcomes. The United Kingdom experience for the period 1992-2012 is reported in this article. A retrospective analysis of patients, preoperatively fulfilling the PoPH European Respiratory Society Task Force on Pulmonary-Hepatic Vascular Disorders diagnostic criteria was conducted across all UK LT centers. Data collection included comorbidities, use of preoperative and postoperative pharmacotherapy, patient survival, and cause of death. To enable survival stratification, PoPH was classified as mild, moderate, or severe based on mean pulmonary pressure of <35 mm Hg, 35-49 mm Hg, and ≥50 mm Hg, respectively. Of 127 patients reported to have PoPH, just 28 fulfilled the diagnostic criteria (14 mild, 9 moderate, 5 severe). Twenty (71.4%) patients were male with median age and Model for End-Stage Liver Disease of 50 years (range, 23-62 years) and 18 (range, 6-43), respectively. Twelve (42.9%) patients died within 5 years of LT. The majority of deaths (10 of 12; 83%) occurred within the first 6 months after LT, aetiologies of which included right heart failure (n = 3), progressive PoPH (n = 2), and sepsis (n = 2). Of those receiving preoperative pharmacotherapy (n = 8), 5 are currently alive and were classified as mild to moderate PoPH. Both severe PoPH patients optimized preoperatively with pharmacotherapy died within a year of LT. Development of effective vasodilatory therapies in the setting of pulmonary arterial hypertension has led to a dramatic improvement in patient survival. The available data indicate that in this era of pharmacotherapy, PoPH in isolation no longer represents a valid consideration to transplant. Liver Transplantation 22 1637-1642 2016 AASLD.

Details

Original languageEnglish
Pages (from-to)1637-1642
Number of pages6
JournalLiver Transplantation
Volume22
Issue number12
Early online date5 Nov 2016
Publication statusPublished - Dec 2016