Portopulmonary hypertension (PPH) is an uncommon but a serious complication of chronic liver disease. Once it develops, it is accepted as a poor prognostic factor in the follow up of patients with liver transplantation (LT). The presence of severe PPH is an accepted contraindication to LT. In this study we sought to identify the prevalence and the impact of PPH on the outcome of patients with LT. The records of 114 adult orthotopic LT patients operated at our institution were retrospectively analyzed. A complete transthoracic Doppler echocardiographic examination was performed preoperative and postoperatively. To identify PPH, patients with Doppler echocardiographically measured pulmonary artery systolic pressure (PASP) values of ≥30mmHg were accepted as PPH. In LT patients with PPH, etiology of the liver disease, postoperative mortality rates and pulmonary complications were noted. In 24 patients PPH was detected. The prevalence of PPH in patients referred for LT was 21.1%. The mean age was 44.0 ± 13.5 years and 18 patients (75.0%) were male. With regard to Child classification 16 (66.7%) patients were found to be in class C. The mean PASP was 46.6 ± 7.6 mmHg. Compared to preoperative values, a significant decrease in mean PASP was noted postoperatively (46.6 ± 7.6 mmHg vs 37.8 ± 15.5 mmHg; P<0.05). Concerning the postoperative pulmonary complications; pneumonia was developed in 7 (29.2%), pleural effusion in 6 (25%), and respiratory failure and right ventricular failure in 1 (4.2%) patient. Compared to patients with a normal PASP, postoperative pulmonary complication rate was higher, and the length of hospitalization was longer in patients with PPH (P<0.05), however no difference was observed in terms of mortality rates (P>0.05). This study indicates that the level of PASP decreases in patients with PPH following LT. Although there was an increase in pulmonary complications, we observed no alteration in mortality rates in this patients group. Therefore we can suggest that PPH may not be regarded as a contraindication for LT.
Volume : 6
Issue : 4
Pages : 164
Department of Pulmonary Diseases, Baskent University Faculty of Medicine, Ankara, Turkey