Division of Solid Organ Transplant and Vascular Anesthesia, Department of Anesthesiology, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA.
J Hepatobiliary Pancreat Sci. 2010 Jul;17(4):505-8. doi: 10.1007/s00534-009-0255-7. Epub 2010 Feb 6.
BACKGROUND/PURPOSE: The diagnosis of porto-pulmonary hypertension (PPHN) in patients with end-stage liver disease at the time of surgery is not an uncommon occurrence. The decision to proceed with orthotopic liver transplantation (OLT) in patients with severe PPHN is associated with high perioperative mortality. We sought to determine the progression of PPHN and patient outcome following aborted OLT.
A retrospective analysis of 2150 OLT cases was performed.
The analysis revealed that six cases (0.3%) were cancelled due to severe PPHN at the time of surgery. The progression to severe PPHN occurred on median over a period of 82 days (range 10-229 days). Following aborted OLT, three patients (50%) expired shortly after.
Cancellation of OLT due to severe pulmonary hypertension was also associated with high mortality. Moreover, this preliminary study reveals that once diagnosed, PPHN can progress to a more severe form over a short period of time. Therefore, we recommend more frequent monitoring of PPHN in this population of patients.
背景/目的：在手术时诊断终末期肝病患者的肺高压（PPHN）并不罕见。对于严重 PPHN 患者，决定进行原位肝移植（OLT）与高围手术期死亡率相关。我们试图确定 OLT 中止后 PPHN 的进展和患者的结局。
对 2150 例 OLT 病例进行了回顾性分析。
分析显示，由于手术时严重的 PPHN，有 6 例（0.3%）被取消。严重 PPHN 的进展中位数为 82 天（范围 10-229 天）。OLT 中止后，有 3 名患者（50%）在短时间内死亡。
OLT 因严重肺动脉高压而取消也与高死亡率相关。此外，这项初步研究表明，一旦确诊，PPHN 可在短时间内发展为更严重的形式。因此，我们建议在这部分患者中更频繁地监测 PPHN。
