DeMartino Erin S, Cartin-Ceba Rodrigo, Findlay James Y, Heimbach Julie K, Krowka Michael J
1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.2 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Scottsdale, AZ.3 Department of Anesthesiology, Mayo Clinic, Rochester, MN.4 William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.5 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN.
Transplantation. 2017 Jan;101(1):101-106. doi: 10.1097/TP.0000000000001517.
Pulmonary hypertension (PH) exists when mean pulmonary artery pressure (mPAP) is 25 mm Hg or greater. mPAP of 35 mm Hg or greater, with increased pulmonary vascular resistance from portopulmonary hypertension, has been associated with increased post-liver transplant (LT) mortality. However, mPAP of 35 mm Hg or greater can also occur in the setting of normal pulmonary vascular resistance from a high flow state and/or increased pulmonary venous volume. We describe the frequency of patients with mPAP of 35 mm Hg or greater at LT and correlate their clinical outcomes with hemodynamic characteristics.
We reviewed hemodynamics of 300 consecutive adult patients undergoing LT. Primary and secondary outcomes were transplant hospitalization mortality and 1-year mortality.
Overall, PH was documented in 117 (39%) of 300 transplant recipients. Five patients were receiving ongoing treatment for portopulmonary hypertension at the time of transplant. mPAP of 35 mm Hg or greater was seen in 31 of 300 patients (10.3%; median, 38 mm Hg; range, 35-46 mm Hg). No intraoperative deaths occurred. Transplant hospitalization mortality was 0% for those with mPAP of 35 mm Hg or greater (vs 2.2% if mPAP < 35 mm Hg, P = 1.0). One-year mortality was similar for patients with and without mPAP of 35 mm Hg or greater (3.2% vs 6.0%, P = 1.0). No deaths were associated with right heart failure.
At the time of LT, 39% of recipients had PH (mPAP ≥ 25 mm Hg) and 10.3% had mPAP ≥ 35 mm Hg. When associated with a high flow state and/or increased volume, transplant hospitalization and 1-year posttransplant outcomes were not adversely affected.
当平均肺动脉压（mPAP）达到或高于25 mmHg时，即存在肺动脉高压（PH）。mPAP达到或高于35 mmHg，且因门肺高压导致肺血管阻力增加，这与肝移植（LT）后死亡率升高有关。然而，mPAP达到或高于35 mmHg也可能出现在肺血管阻力正常但处于高流量状态和/或肺静脉血容量增加的情况下。我们描述了LT时mPAP达到或高于35 mmHg的患者的频率，并将他们的临床结局与血流动力学特征相关联。
我们回顾了300例连续接受LT的成年患者的血流动力学情况。主要和次要结局分别为移植住院死亡率和1年死亡率。
总体而言，300例移植受者中有117例（39%）记录有PH。5例患者在移植时正在接受门肺高压的持续治疗。300例患者中有31例（10.3%）mPAP达到或高于35 mmHg（中位数为38 mmHg；范围为35 - 46 mmHg）。术中无死亡病例。mPAP达到或高于35 mmHg的患者移植住院死亡率为0%（mPAP < 35 mmHg者为2.2%，P = 1.0）。mPAP达到或高于35 mmHg和未达到该标准的患者1年死亡率相似（分别为3.2%和6.0%，P = 1.0）。无死亡病例与右心衰竭相关。
在LT时，39%的受者有PH（mPAP≥25 mmHg），10.3%的受者mPAP≥35 mmHg。当与高流量状态和/或血容量增加相关时，移植住院及移植后1年的结局未受到不利影响。
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