Rajaram P, Parekh A, Fisher M, Kempker J, Subramanian R
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia, USA.
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia, USA.
Transplant Proc. 2017 Mar;49(2):338-343. doi: 10.1016/j.transproceed.2016.12.006.
In potential liver transplant candidates, pulmonary vascular diseases, including portopulmonary hypertension (PoPH) and pulmonary venous hypertension (PVH), can be associated with high morbidity and mortality. Although there are clear guidelines regarding management and transplant listing criteria for patients with PoPH, the listing criteria for PVH are not well defined.
The aim of this study was to describe and compare the perioperative and postoperative morbidity and mortality associated with PoPH and PVH in patients undergoing liver transplantation.
We conducted a retrospective observational study of all patients referred for liver transplantation to our center between 2005 and 2015 who underwent a right heart catheterization (RHC) for screening for pulmonary hypertension as suggested by initial echocardiography. Based on the RHC data, the patients were grouped into no pulmonary hypertension (No PH), PoPH, and PVH categories. In patients who underwent liver transplantation, we recorded vital status intraoperatively and at 30 days and 1-year post-transplant, and we recorded the incidence of postoperative cardiopulmonary and renal complications.
Of the 134 patients who underwent RHC as part of the initial transplant evaluation, 50 patients were successfully transplanted. There was 1 intraoperative death in the PoPH group. No significant difference in mortality was noted between the No PH, PoPH, and PVH groups intraoperatively and 30 days after liver transplantation. At 1 year, the survival rates were 100%, 69.2%, and 94.1% in the No PH, PoPH, and PVH groups, respectively. With respect to cardiopulmonary and renal complications, no statistically significant difference was noted among the groups, though there was a trend toward increased post-transplant reversible pulmonary complications in the PVH group.
Our findings suggest that the post-transplant outcomes of patients with PoPH and PVH are similar. In light of the growing recognition of diastolic dysfunction and cirrhotic cardiomyopathy in decompensated cirrhotic patients at the time of transplant, the issue of pulmonary hypertension related to PVH will gain increasing importance as we assess these patients for transplantation. Therefore, future studies are needed to define evidence based guidelines to determine candidacy for liver transplantation in the context of PVH.
在潜在的肝移植候选者中，肺血管疾病，包括门脉性肺动脉高压（PoPH）和肺静脉高压（PVH），可能与高发病率和死亡率相关。尽管对于PoPH患者的管理和移植列入标准有明确的指南，但PVH的列入标准尚未明确界定。
本研究的目的是描述和比较肝移植患者中PoPH和PVH相关的围手术期及术后发病率和死亡率。
我们对2005年至2015年间转诊至我们中心进行肝移植且根据初始超声心动图建议接受右心导管检查（RHC）以筛查肺动脉高压的所有患者进行了一项回顾性观察研究。根据RHC数据，将患者分为无肺动脉高压（No PH）、PoPH和PVH组。对于接受肝移植的患者，我们记录了术中、移植后30天和1年时的生命状态，并记录了术后心肺和肾脏并发症的发生率。
在作为初始移植评估一部分接受RHC的134例患者中，50例患者成功进行了移植。PoPH组有1例术中死亡。No PH组、PoPH组和PVH组在术中及肝移植后30天的死亡率无显著差异。1年时，No PH组、PoPH组和PVH组的生存率分别为100%、69.2%和94.1%。关于心肺和肾脏并发症，各组之间未观察到统计学上的显著差异，尽管PVH组移植后可逆性肺部并发症有增加的趋势。
我们的研究结果表明，PoPH和PVH患者的移植后结局相似。鉴于在移植时对失代偿期肝硬化患者舒张功能障碍和肝硬化性心肌病的认识不断增加，在评估这些患者进行移植时，与PVH相关的肺动脉高压问题将变得越来越重要。因此，需要未来的研究来确定基于证据的指南，以确定PVH背景下肝移植的候选资格。
