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Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol
Author(s) -
Tan Henkie P.,
Markowitz Jay S.,
Montgomery Robert A.,
Merritt William T.,
Klein Andrew S.,
Thuluvath Paul J.,
Poordad F. Fred,
Maley Warren R.,
Winters Bradford,
Akinci Seda B.,
Gaine Sean P.
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.26057
Subject(s) - medicine , portopulmonary hypertension , contraindication , liver transplantation , pulmonary artery , vascular resistance , transplantation , cardiology , pulmonary hypertension , hemodynamics , surgery , alternative medicine , pathology
Portopulmonary hypertension (PPHTN) is no longer an absolute contraindication to orthotopic liver transplantation (OLT). The pre‐OLT management of patients with PPHTN requires early diagnosis and chronic therapy with intravenous epoprostenol to decrease pulmonary vascular resistance (PVR). Close follow‐up is necessary to reassess pulmonary artery pressures (PAPs) and evaluate right ventricular (RV) function. This assists in the optimal timing of OLT. Successful management also necessitates reassessment of pulmonary artery hemodynamics just before OLT, with clearly defined parameters used to determine whether to proceed. Even with the intraoperative and postoperative availability of potent pulmonary vasodilators, clinical management may be suboptimal in reducing PAP. Adequate reduction in PVR and improvement in RV function in response to chronic epoprostenol therapy may facilitate successful OLT. We present a case report and review the limited experience with this treatment.