Saner Fuat H, Nadalin Silvio, Pavlaković Goran, Gu Yanli, Olde Damink Steven W M, Gensicke Julia, Fruhauf Nils R, Paul Andreas, Radtke Arnold, Sotiropoulos Georgios C, Malagó Massimo, Broelsch Christoph E
Department of General Surgery and Transplantation, University Clinic Essen, Germany.
Transplantation. 2006 Oct 15;82(7):887-91. doi: 10.1097/01.tp.0000235520.37189.fe.
Portopulmonary hypertension (PPH) is a severe complication of liver cirrhosis, which poses a high risk for postliver transplantation (LT) mortality. In most liver transplant centers, severe PPH is viewed as an absolute contraindication for LT, but recent reports challenge this. The purpose of our study was to determine the incidence of PPH, its influence on the 30-day mortality rate following LT and to determine the sensitivity and specificity of Doppler echocardiography and electrocardiography as noninvasive tools to determine PPH.
We studied 74 consecutive patients that underwent LT between February 2004 and November 2005. Pulmonary arterial pressure and cardiac index were repeatedly determined during surgery and postoperatively. PPH was defined as mild (mean pulmonary arterial pressure (MPAP) 25-35 mm Hg), moderate (MPAP of 35-45 mm Hg) and as severe (MPAP >45 mm Hg).
The total incidence of PPH was 31% (16 mild, 5 moderate, and 2 severe). There was a tendency towards increased 30-day mortality rate in patients with PPH compared to controls (22% vs. 12%, P=0.1). However, the two patients with the most severe PPH survived. The duration of ventilation and total stay at the intensive care unit did not differ significantly between groups. The positive predictive value of Doppler echocardiography for PPH was 39% and the negative predictive value 90%.
Mild pulmonary hypertension is common in patients with liver failure, whereas moderate and severe hypertension is not. Severe PPH should not be considered as absolute contraindication for LT.
肝肺综合征（PPH）是肝硬化的一种严重并发症，对肝移植（LT）后的死亡率构成高风险。在大多数肝移植中心，严重PPH被视为LT的绝对禁忌症，但最近的报告对此提出了挑战。我们研究的目的是确定PPH的发生率、其对LT后30天死亡率的影响，并确定多普勒超声心动图和心电图作为确定PPH的非侵入性工具的敏感性和特异性。
我们研究了2004年2月至2005年11月期间连续接受LT的74例患者。在手术期间和术后反复测定肺动脉压和心脏指数。PPH被定义为轻度（平均肺动脉压（MPAP）25-35mmHg）、中度（MPAP为35-45mmHg）和重度（MPAP>45mmHg）。
PPH的总发生率为31%（16例轻度、5例中度和2例重度）。与对照组相比，PPH患者的30天死亡率有增加的趋势（22%对12%，P=0.1）。然而，两名PPH最严重的患者存活下来。两组之间的通气时间和在重症监护病房的总停留时间没有显著差异。多普勒超声心动图对PPH的阳性预测值为39%，阴性预测值为90%。
轻度肺动脉高压在肝衰竭患者中很常见，而中度和重度高血压则不然。严重PPH不应被视为LT的绝对禁忌症。
