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Living‐donor liver transplantation for moderate or severe porto‐pulmonary hypertension accompanied by pulmonary arterial hypertension: a single‐centre experience over 2 decades in Japan
Author(s) -
Ogawa Eri,
Hori Tomohide,
Doi Hiraku,
Segawa Hajime,
Uemoto Shinji
Publication year - 2012
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-011-0453-y
Subject(s) - medicine , pulmonary hypertension , vascular resistance , cirrhosis , liver transplantation , cardiology , portal hypertension , living donor liver transplantation , transplantation , portopulmonary hypertension , surgery , blood pressure
Background Candidates for orthotopic liver transplantation (OLT) often have porto‐pulmonary hypertension (PPHTN) with pulmonary arterial hypertension (PAH). Poor outcomes of PPHTN contraindicate OLT. There are no guidelines for living‐donor liver transplantation (LDLT) in PPHTN patients. Methods We present our experiences of LDLT in six patients with moderate or severe PPHTN, along with our institutional guidelines. Three had liver cirrhosis and three were non‐cirrhotic. Catheterization studies were undertaken before, during and after LDLT, and the mean pulmonary arterial pressure (mPAP), cardiac output (CO), pulmonary vascular resistance and total peripheral resistance (TPR) were monitored. Results The results showed significant differences in CO and TPR between cirrhotic and non‐cirrhotic patients before, during and after LDLT. Cirrhotic patients showed systemic hyperdynamic state. Two cirrhotic patients showed poor responses to pre‐transplant treatment, and continued to have increased PAH and poor clinical courses after LDLT. LDLT has an advantage of flexible timing of LT. Currently in our institution, PPHTN patients with mPAP <40 mmHg are registered for LDLT after treatment and catheterization. However, LDLT is performed when mPAP is ⩽35 mmHg, leading to improved outcomes. Conclusion PPHTN patients with well‐controlled PAH, or secondary PAH resulting from porto‐systemic shunts, may be appropriate candidates for LDLT after careful considerations.